Democratic 2020 Contenders Spar Over Health Policy

A flurry of proposals to slap new taxes on the ultra-wealthy, extend Medicare to all Americans and make college debt-free reflect a rapidly changing Democratic Party that sees a sharp left turn as the path to defeating President Donald Trump.

Some of the party’s top 2020 presidential hopefuls are wading into uncharted political waters in an effort to demonstrate their commitment to mitigating income inequality.

But where party activists see an opportunity to excite voters, some veterans of past campaigns and moderate Democrats warn that the party wins elections not by indulging its most liberal impulses but by hewing to the political center. And Trump has made clear he’s ready to use the leftward tilt by Democrats as a wedge issue in 2020.

Five U.S. senators with eyes on the Democratic nomination have endorsed single-payer health insurance, a government-guaranteed job, and subsidies to ensure Americans can graduate from college free of debt. Kamala Harris also wants a $3 trillion tax cut for families under $100,000. Elizabeth Warren wants a yearly wealth tax on assets above $50 million. Cory Booker wants “baby bonds” for poorer kids to bridge racial inequities. Bernie Sanders wants a massive expansion in the estate tax.

“The Democrats are swinging for the fences this time,” said Stephanie Kelton, an economist who advised Sanders in his bid for the 2016 Democratic nomination. “You’re seeing kind of a return to the roots of the Democratic Party in the FDR era.”

FDR’s Agenda

Much like Franklin Delano Roosevelt did in the 1930s, Democratic contenders are pushing tax hikes on the wealthy to finance an expansion of government security programs. They’re also seeking to make good on Roosevelt’s “Second Bill of Rights” that he proposed in the 1944 State of the Union, one year before he died and the goal fizzled.

“The things that FDR enumerated in that speech — the right to a living wage and job and education and housing and secure retirement — that’s big stuff, and you have someone on the Democratic side with legislation for almost everything on that agenda,” Kelton said.

The Democratic hunger for more liberal policy prescriptions — as well as leaders who reflect the demographics of a party reliant on young people, minorities and women — was evident in the 2018 elections as upstarts like Representatives Ayanna Pressley of Boston and Alexandria Ocasio-Cortez of New York ousted longtime Democratic incumbents.

No ‘Half-Measures’

“People are sick of half-measures,” said Sen. Brian Schatz of Hawaii. “Americans are struggling mightily to get into the middle class, or stay in the middle class, and the job of the Democratic Party is to come up with a real program to solve those problems.”

The issue that has most energized the progressive base is a “Medicare for all” system that would establish a federal insurance program and scrap most private insurance. Legislation called the Medicare For All Act, unveiled in 2017 by Sanders, of Vermont, has been cosponsored by 2020 hopefuls in the Senate like Harris of California, Warren of Massachusetts, Booker of New Jersey, and Kirsten Gillibrand of New York. Sanders plans to reintroduce the Medicare For All Act in the new Congress.

Medicare for All

At a CNN town hall last week in Iowa, Harris offered a ringing endorsement of Medicare for all and said she’d do away with private insurance. “Let’s eliminate all of that,” she said, after describing its hassles. Warren took a more cautious approach, declining twice on Bloomberg TV to say if she’s scrap private insurers as part of her plan, saying that she sees “lots of paths” to universal coverage.

“We know where we’re aiming, and that is every American has health care at a price they can afford,” Warren said.

The eagerness among Democratic hopefuls to reverse the party’s centrist turn in the 1990s is drawing pushback from some of its architects, who credit the shift for Bill Clinton’s success in breaking years of Republican dominance in presidential elections.

“Our view is that Medicare for all would be a catastrophic idea for the Democratic nominee to run on in 2020,” said Matt Bennett, a spokesman for the centrist Democratic group Third Way.

‘Dangerous’ Litmus Tests

Bennett said progressive litmus tests like single payer are “dangerous” if the party wants to unseat Trump. “Medicare for all does well on Twitter and in riling up base voters, but in the end is not going to be politically resonant in the places where Democrats simply must win, which is the former blue wall states of Michigan, Wisconsin and Pennsylvania,” he said.

But Democratic Sen. Tammy Baldwin won re-election in November by more than 10 points in Wisconsin on an unabashedly progressive platform that included Medicare for all. In an interview, she rejected the idea that running to the left would hurt her party’s prospects in the state, which Trump won in 2016. Democratic candidates are “all pushing in the direction that anyone from Wisconsin would want,” she said.

Keeping Distance

While outspoken progressives like Ocasio-Cortez drove the conversation, Democrats took control of the House in 2018 by capturing seats from Republicans in moderate districts. Many of those Democrats are keeping their distance from Medicare for all and other ideas gaining steam on the left, wary of how they’d fare with more conservative voters.

“We can’t forget that the way we won the House majority was through the middle,” said Rep. Josh Gottheimer, who won a competitive district in northern New Jersey.

The early tone of the Democratic primary debate provides a marked contrast from Hillary Clinton’s winning 2016 campaign. She rejected Medicare for all and debt-free college in favor of ideas she described as more pragmatic, such as improving the Affordable Care Act marketplaces and incremental steps to mitigate student debt.

She won, but not before an unexpectedly strong challenge from Sanders.

’Free College Is Crazy’

“Hillary had a progressive approach but it was a pragmatic progressive approach. Bernie’s approach was — you could call it more progressive but he was not pragmatic. Free college is crazy, who’s going to pay for it?,” said Adrienne Elrod, a former spokeswoman for Clinton’s 2016 campaign. “But one of the reasons Bernie did catch on is he really spoke to income inequality. Bernie’s message tended to stick out.”

Elrod said that Medicare for all is popular because “people are seeing that the ACA, especially with the individual mandate gone, is not working for them. Their health care costs are still escalating. It’s an issue that’s going to drive this election, so anyone who takes a half-assed approach to it and does not support a more progressive health care position is going to lose.”

Medicare for all may face opposition from more moderate Democrats weighing a run. Former Vice President Joe Biden has long resisted the idea, though he hasn’t discussed it recently. Former New York Mayor Michael Bloomberg, who is considering a run for the Democratic nomination, said recently that it would “bankrupt for us for a very long time.” Bloomberg is the founder and majority owner of Bloomberg LP, the parent company of Bloomberg News.

“There’s still that middle section of the country that wants a more moderate approach to governing. So yes, there’s always a danger,” Elrod said. “But you’re not going to get through a Democratic primary if you take moderate stances on very high-profile important economic issues like health care like income inequality.”

Some Republicans say they worry that a left-wing candidate could win the presidency.

“I am certainly concerned that the Democrats might nominate someone on the extreme left, and such a candidate could potentially win,” said Sen. Ted Cruz of Texas, the runner-up for the 2016 Republican nomination. “In a closely divided country, all sorts of outcomes are possible.”