Why Are Democrats Afraid to End Private Health Insurance?

Voters from both sides of the aisle are starting to support the idea of national health insurance, or Medicare for all, but just two of the ten candidates on stage for the first Democratic debate—Bill de Blasio and Elizabeth Warren—were willing to say they’d abolish private insurance. Another candidate, Beto O’Rourke, had previously expressed support for national health insurance, and Sen. Cory Booker, D-N.J., had been a co-sponsor of a Medicare for all bill. The rest were firmly against it.

According to a June Kaiser Family Foundation poll, 56% of Americans support a national health care plan, i.e., Medicare for all. Two 2018 polls, from Hill-HarrisX and Reuters-Ipsos found that nearly 80% of respondents supported the concept, although as the Kaiser poll indicates, many Americans are confused about the details, such as whether premiums, deductibles and co-pays would still exist, and if so, whether employers or individuals would pay for them.

Perhaps it’s that confusion that made eight candidates so timid. As Dylan Scott explains in Vox, “employer-sponsored insurance is one of the biggest challenges for single-payer health care.” As many as 150 million people get their insurance from their employers, Scott continues, and under the bill put forth by Sen. Bernie Sanders, I-Vt., they’d be moved to a government-sponsored plan within a few years of the bill’s passage.

Democrats who want to keep private insurance argue that, as Scott writes, “it’s too big a political risk to disrupt health insurance for half the population.” Instead, he says, they’d prefer “Medicare ‘for all who want it’ or a public option for Obamacare’s marketplaces, allowing more people to voluntarily buy into a government plan, but wouldn’t make it mandatory.”

In the past, Elizabeth Warren has been more muted in her support for a national plan, telling The New York Times in its candidate survey that there are multiple paths to getting to Medicare for all. On Wednesday night, Warren was direct: “Look at the business model of an insurance company,” she said. “It’s to bring in as many dollars as they can in premiums and to pay out as few dollars as possible for your health care. That leaves families with rising premiums, rising co-pays, and fighting with insurance companies to try to get the health care that their doctors say that they and their children need.”

Beto O’Rourke, who, as Scott points out, previously supported Medicare for all, said Wednesday that he now supports the Medicare for America bill that would keep private insurance but would allow Americans to join a government plan if they’d prefer. He was challenged by Bill de Blasio, the only other candidate besides Warren to commit to abandoning private insurance. De Blasio said, “Congressman O’Rourke, it’s not working for tens of millions of Americans when you talk about the premiums and the out-of-pocket expenses.” The New York City mayor then asked, “How can you defend a system that is not working?”

Cory Booker declined to raise his hand to say he’d abolish private insurance. In fact, he remained light on details for anything health care-related, saying only that “Every single day I will fight to give people more access and affordable cost until we get to every American having health care.”

He, and any of the 20-plus Democrats running for president, may not be able to remain vague much longer. Among Democrats and Democrat-leaning independents, another KFF poll shows that 87% of those groups think it is “very important” for Democratic presidential candidates to talk about health care during their debates.

The second debate is scheduled for Thursday night.