The struggle within the Democratic party over the future of health care policy and the role of employer-provided coverage was on full display over the course of the two nights of presidential primary debates this week. None of the differences between progressives pushing for elimination of employer coverage as part of their Medicare-for-all proposals and moderates looking to build on the Affordable Care Act (ACA) were resolved, but the battle lines -- if not the policy details -- became clearer.
While Sen. Kamala Harris (D-CA) promoted her new plan that tries to split the difference between progressives and moderates by turning Medicare into a universal program while preserving some form of employer coverage, the other candidates presented the starkest contrast to date on whether to force people off private coverage.
Progressive senators Bernie Sanders (I-VT) and Elizabeth Warren (D-MA) insisted that the only universal coverage plan worth passing is a single-payer plan that effectively eliminates private insurance. Sanders' Medicare-for-all legislation would grant generous benefits with no premiums or copays while eliminating most private coverage. And some longshot candidates like New York City Mayor Bill de Blasio and businessman Andrew Yang argued that health insurance should be de-coupled from employment.
Moderates, including current front-runner and former vice president Joe Biden, argued that these sweeping reforms are unrealistic and politically counter-productive, massively raising taxes and making employer-based coverage “illegal.” That's a view shared by most of the Democratic field. Biden tried to drive that point home by noting that his more moderate plan – which would expand coverage through the ACA and a Medicare-based public plan option – would cost a fraction of the progressives’ government-run Medicare-for-all plans and be less disruptive.
A Kaiser Family Foundation poll appears to support that view, indicating that public support for Medicare-for-all drops significantly when people are informed about potential tax increases or elimination of private insurance. The Kaiser poll properly points out that, while proposals for a government-run universal coverage system may be popular “in the abstract,” whether they can attract broader support during the 2020 election or beyond is a big open question.