Joe Biden on Monday endorsed a public option that would allow all Americans to buy into a Medicare-like health insurance plan, as allies of both the former vice president and 2020 presidential rival Sen. Bernie Sanders (I-Vt.) begin to debate the Democratic Party’s health-care agenda.
“Whether you’re covered through your employer or on your own or not, you should have the choice to buy into a public option plan for Medicare — your choice,” Biden said during a campaign event in Pittsburgh. “If the insurance company isn’t doing right by you, you should have another choice.”
Sanders has called for enrolling every American on the Medicare program — a “single-payer” system — and an aide to the campaign took a swipe at Biden’s decision to attend a private fundraiser that included health insurance executives last week.
Biden’s plan would create a new government option for patients in the marketplace exchanges that would aim to lower prices for individual Americans by competing directly with private plans, according to a policy adviser for Biden, who spoke on the condition of anonymity to share details of the proposal. Employers would also be able to buy into the public plan. Additional details about the plan will be released later in the campaign.
Biden is also expected to say he shares with single-payer activists the goal of universal coverage and lower health-care costs, but that he does not support Medicare-for-all, the adviser said. He may reprise Hillary Clinton’s argument in 2016 that her more incremental approach would build on the policies of the Obama administration, rather than replacing the Affordable Care Act with a single-payer system.
“We are all trying to get to a place where we achieve universal health care. I think he sees it like that,” the adviser said. “But if they want to go after him and Obama about their approach to health care, bring it on.”
Supporters of Medicare-for-all also reject the idea that single-payer amounts to a rejecting of Barack Obama’s legacy, noting the former president recently called it a good idea. Sanders voted for the Affordable Care Act and campaigned hard against Republican attempts to repeal it in 2017.
A campaign aide to Sanders also criticized Biden in a statement for attending a private fundraiser with health insurance executive Daniel Hilferty at the Philadelphia home of a Comcast executive, according to a copy of the invitations first obtained by Politico.
“Anyone defending the current dysfunctional system needs to explain why the average family should have to pay $28,000 a year for health care, while the CEO of Independence Health Group Daniel Hilferty made $4.8 million last year,” an aide to Sanders’s campaign said in a statement.
The disagreement between Sanders and Biden reflects the Democratic Party’s policy and philosophical rift over health care, an argument that could help shape the party’s agenda on health care as the 2020 election intensifies.
Biden and Sanders are leading the field, although polling shows the race is wide open, with most voters still undecided. Many of the other leading Democratic presidential candidates — including Sens. Kamala D. Harris (Calif.) and Elizabeth Warren (Mass.), as well as Pete Buttigieg, mayor of South Bend, Ind. — have said they support the idea of Medicare-for-all. But they have also expressed unease about outlawing private insurers, while Sanders has said they should be “virtually” abolished.
The core of the dispute is how radically the government needs to transform the U.S. health-care system.
Centrist Democrats, as well as the insurance industry, have argued the United States does not need to adopt single-payer to lower costs and extend health insurance to the 30 million Americans who don’t have it. They have also expressed little desire to upend employer-based health insurance, which more than 100 million Americans use to receive their care, and they worry about the political consequences of doing so.
Although key details remain unclear, Biden’s plan to create a Medicare public option could give consumers much less expensive insurance without the limited networks that exist in private insurance plans, said Larry Levitt, a health policy expert at the Kaiser Family Foundation, a nonpartisan group.
“The notion that a Medicare public option is now seen as a moderate idea shows how much the health-care debate has shifted among Democratic candidates,” Levitt said. “It doesn’t go as far as Medicare-for-all in simplifying the system, but it may avoid some of the political pitfalls.”
But single-payer activists say these smaller fixes to the ACA are inadequate to confront the crisis of American health care, which most voters listed as their top priority in the 2018 midterm elections.
Single-payer supporters note that the United States spends about twice as much per gross domestic product than any other nation on health care, despite trailing most peer nations on a number of key health indexes, such as life expectancy and obesity. A single-payer system would enroll all Americans on the same insurance plan and use the government’s leverage to discipline health-care prices, at least in theory.
“Incremental reforms will leave millions of people without health care — black people, people of color, people in rural America,” said activist Ady Barkan, who is testifying in Congress this week in support of Medicare-for-all, adding that he would like to ask Biden: “Which community are you willing to sacrifice in favor of enriching insurance industry executives?”