(Bloomberg) -- In April, many of the top Democratic presidential candidates eagerly lined up to co-sponsor Bernie Sanders’ Medicare for All bill -- a vast restructuring of the U.S. health-care system that would go far beyond Obamacare.Senators Elizabeth Warren, Kamala Harris, Cory Booker and Kirsten Gillibrand, along with Representatives Tim Ryan and Tulsi Gabbard, all co-sponsored the bill with an eye toward the upcoming presidential primaries.“It was a recognition that the center of gravity in the party has moved in a much more progressive direction,” said Jeff Weaver, a senior adviser to the Sanders campaign. “Many candidates wanted to position themselves with the vast majority of Democratic primary voters by supporting real Medicare for All.”But as this week’s Democratic debates in Detroit illustrated, many of those initial co-sponsors, fearful of blowback from voters -- particularly those who have satisfactory private health insurance they’re reluctant to give up for something unknown, as they would have to under Sanders’s plan -- have begun backing away.Sanders’s Medicare For All would expand to all American residents the government-run health insurance program that’s covered senior citizens and certain other people for over 50 years. But as the costs and disruptions of the plan have come into focus, Medicare for All has emerged as the major fault line in the Democratic presidential primary.Top IssueHealth-care coverage consistently ranks as the top issue for Democrats and helped drive the party’s electoral gains in 2018. But polls show that voters harbor deep concerns about the possible disruption from a policy as far-reaching as Sanders has proposed.The two-night gathering in Detroit made clear that the biggest fight in Democratic politics right now is whether the party should press ahead with remaking the health care system, which accounts for 18% of U.S. gross domestic spending, or instead pursue more limited reforms along the lines of front-runner Joe Biden’s proposal to “build on Obamacare,” the signature legislative achievement of President Barack Obama.“At the level of the bumper sticker or talking points, proposals are very popular, but when you start filling in the details and the trade-offs become clear, it becomes more apparent that there are losers as well as winners,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “At the bumper sticker level, it seems that everyone is a winner.”A PBS NewsHour/Marist poll of U.S. adults conducted July 15-17 highlighted the Democrats’ dilemma. It found that while 70% of respondents favor a Medicare for All option, only 41% support doing away with private health insurance. A recent tracking poll from the Kaiser Family Foundation showed overall favorability for a Medicare for All system dropped to 51% in July from 56% in April. It also found that more Democrats, 55%, prefer to expand coverage by bolstering the Affordable Care Act than the 39% who believe in replacing Obamacare with a Medicare for All system.During the debates, Booker and Gillibrand both dodged questions about the role of private insurance under a Medicare for All regime. Instead, they sought to re-frame the conversation about health care in broader terms, drawing a contrast between Democrats and Republicans.“This pitting progressives against moderates, saying one is unrealistic and the other doesn’t care enough, that to me is dividing our party and demoralizing us in face of the real enemy here,” Booker said. Forest Versus TreesGillibrand said the intra-party squabbling risked “losing the forest through the trees.”Harris, in particular, has struggled to stick to a clear position on Medicare for All. The California senator was the first Democrat to co-sponsor Sanders’ bill and raised her hand when moderators at the June debates asked which candidates would be comfortable abolishing private health insurance. Harris later backtracked, saying she’d misheard the question.“She violated a rule I’ve promulgated in politics: if you’re caught in a bind and can’t think of any way out of it, don’t say something that no one will believe,” said Barney Frank, the former Democratic representative from Massachusetts, who’s not endorsed a presidential candidate for 2020.On July 29 Harris introduced her own, less ambitious Medicare for All plan that also allows private insurance coverage and would be phased in over a decade.Kate Bedingfield, a spokeswoman for former Vice President Joe Biden’s campaign, assailed it as a “have-it-every-which-way approach” that would raise middle class taxes. Biden amplified that charge during the debate by saying, “You can’t beat President Trump with double-talk on this plan.”Valuable BrandHarris shot back that the Biden campaign was “probably confused because they’ve not read it.”Harris’s plan was also attacked from the left. Weaver said Harris was seeking to co-opt the Medicare for All “brand name” while offering her own, scaled-back plan. “It’s not Medicare for All -- at all,” Weaver said.The most extreme flip-flop belongs to Ryan, who’s still listed as a co-sponsor of Sanders’ Medicare for All legislation in the House but laced into the plan during Tuesday night’s debate. The next day, Ryan continued to warn about the political consequences of eliminating private insurance.“I think we’d lose 48 states, and I’m having a hard time figuring out what the two states are we’re going to win if our lead message is, ‘We’re going to confiscate health care from people,’” he said.Aly Javery, a spokeswoman for Ryan’s campaign, said he remained a cosponsor of Sanders’s plan despite his misgivings because Ryan would like to see the country move toward a Medicare for All system.‘Sucking Value Out’Warren, who hesitated to say she wanted to completely eliminate private insurance in the early months of her campaign, has since leaned into Sanders’ vision of a single-payer Medicare for All system that eliminates private insurance.“Every developed country on earth has moved to a single-payer system because it produces better outcomes at lower cost,” Warren said in a July 17 interview with Bloomberg Businessweek. “The markets, they’re sucking value out without delivering the health care we need.”But even Warren has shied away from acknowledging that a Medicare for All system would raise taxes on the middle class, which Sanders admits. Asked twice by debate moderators in Detroit if the plan she’s endorsed would raise middle class taxes, Warren dodged by replying that “total costs will go down” to obtain health coverage.With the presidential field expected to narrow in the coming weeks as low-performing candidates potentially drop out before the September debates, the health-care discussion will come into sharper focus as proponents and critics of Sanders’ Medicare for All plan meet on a single stage.Even as many of the original sponsors back away, Democratic strategists worry how a nominee like Sanders or Warren, who support the most ambitious version of Medicare for All, would fare in the general election.“Medicare for All’s biggest drawback is that it destroys choice and that it takes away private health insurance from people who have it and like it,” said Bob Shrum, a veteran Democratic strategist who now runs the Center for the Political Future at the University of Southern California.“You could turn an issue that works for Democrats around into an issue that hurts Democrats by telling tens of millions or 100 million people who may like the insurance they have now that they’re going to go into something unknown.”To contact the reporters on this story: Tyler Pager in Washington at tpager1@bloomberg.net;Joshua Green in Washington at jgreen120@bloomberg.netTo contact the editors responsible for this story: Wendy Benjaminson at wbenjaminson@bloomberg.net, Ros KrasnyFor more articles like this, please visit us at bloomberg.com©2019 Bloomberg L.P.
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