The Bernie Sanders revolution hasn’t materialized. Elizabeth Warren is out of the race. Democratic voters say Joe Biden, familiar and unthreatening, is the man they want as their presidential nominee.
This means Medicare for all, the huge government program that would eliminate private insurance, is dead. Sanders is the champion of Medicare for all, and while he’s still in the race, Joe Biden’s surge during the last two weeks has left Sanders campaigning on borrowed time. Data site fivethirtyeight.com now gives Biden a 99% chance of locking up the nomination, while Sanders has less than a 1% chance. The only winning scenario for Sanders is a Biden health emergency or some other form of collapse.
Some Sanders supporters hope Biden will move toward Medicare for all as a way of placating the Sanders wing, once the Vermont senator officially withdraws from the presidential race. Biden won’t do that. His support for more moderate health reform is a key differentiator between him and Sanders, and Biden will need that positioning to win Independents in a general election race against President Trump.
Exit polls from 20 states show 58% of Democratic voters favor Medicare for all, making it seem like a high priority within the party. Just 37% oppose the idea. But that may overstate support for a centralized government health care plan. Separate polling by the Kaiser Family Foundation shows that a majority of people who support Medicare for all mistakenly think it would maintain the private insurance system that covers more than 160 million Americans. By definition, MFA would eliminate private insurance and put everybody—as in “all”—in a government plan. The idea becomes far less popular when pollsters tell respondents MFA would eliminate private insurance.
While Biden doesn’t support Medicare for all, he does support other reforms that would address some of the glaring problems in the health care system. He proposes a government-run “public option,” similar to Medicare, that anybody could buy into if they can’t afford available options in the private market. Enrollees would pay premiums, but those could be lower than many private plans, because the public option would be large and there’d be no profit to skim off the top. In theory, this could pressure private plans to become more efficient and cheaper.
Biden would also take other steps to make the Affordable Care Act, aka Obamacare, work better, such as establishing insurance subsidies for families that earn too much to qualify today. Biden also wants to outlaw “surprise billing,” put caps on some drug prices and repeal the prohibition on Medicare negotiating lower prices with drugmakers.
Though Biden’s public option is less disruptive than Medicare for all, it would still have a hard time getting through Congress. It’s possible no Republicans would vote for it, requiring Democratic control of not just the House, but the Senate for the first time since in a decade. Even some moderate Democrats could be opposed to a new public option, since it could destabilize private insurers by undercutting them in the market. Insurance companies are a powerful lobbying group, and not just among Republicans.
A Biden presidency would be a legitimate test of whether any so-called progressive policies backed by the most liberal Democrats have any chance in Washington. Sanders has a passionate following, but he’s winning less of the vote in the 2020 primaries than he won in 2016. His “revolution” depends on young voters turning out in record numbers, and they’re not. That suggests real political support for progressive policies such as Medicare for all is nowhere near a critical mass. The real question may be whether Democrats could enact even modest changes to an intractable health care system.
Rick Newman is the author of four books, including “Rebounders: How Winners Pivot from Setback to Success.” Follow him on Twitter: @rickjnewman. Confidential tip line: email@example.com. Encrypted communication available. Click here to get Rick’s stories by email.