“Medicare for All” Is Not for Everyone in the Democratic Primary

California Senator Kamala Harris and South Bend Mayor Pete Buttigieg are virtually tied at 6 percent each in the most recent polls in the 2020 Democratic presidential primary. The two have emerged as the party’s rising stars on the campaign trail. Still, their support pales in comparison to former vice president Joe Biden, Vermont Senator Bernie Sanders, and Massachusetts Senator Elizabeth Warren, who each enjoy double-digit support. Democrats seem no more or less likely to nominate Harris than Buttigieg, though a reader would never guess as much when reading recent media coverage. The Week describes Harris’s campaign as having “collapsed,” while FiveThirtyEight broke down “the Buttigieg surge” on the strength of his most recent debate performance in Iowa.

During the debate two weeks ago, Buttigieg challenged Warren to outline the costs and defend the design of “Medicare for All,” the single-payer health insurance proposal that dominates discussion in the primary. “I don’t think the American people are wrong when they say that what they want is a choice,” Buttigieg told Warren. “I don’t understand why you believe the only way to deliver affordable coverage to everybody is to obliterate private plans, kicking 150 million Americans off of their insurance in four short years.” Sanders interjected, “I do think it is appropriate to acknowledge that taxes will go up.”

Harris announced her candidacy in front of 20,000 supporters in Oakland, California, the largest crowd to attend a campaign launch among the field’s many contenders. In the first debate, Harris challenged Biden to defend his opposition to federal busing mandates as a senator in the 1970s. In doing so, Harris underscored Biden’s age while also embodying the party’s diverse and youthful future. Throughout July, Harris peaked in third place—between 10 and 15 percent—in most polls, briefly emerging as the leading alternative to the early front-runners, Biden and Sanders. But then Medicare for All came to dominate the debates, an issue that Democratic voters rank among their greatest concerns, second only to defeating Donald Trump.

Since August, Harris has receded in most polls as she’s struggled to articulate her position on Medicare for All. In the Senate, she cosponsored Sanders’s Medicare for All legislation; on the campaign trail, however, she pledged her support for private insurance, which Medicare for All would replace. “I’ve not been comfortable with Bernie’s plan,” Harris told supporters at an August fundraiser. In recent months, Harris has rendered her health care agenda ambiguous and, thus, inessential. In the most recent debate, Buttigieg called for Warren to defend Medicare for All, while Harris challenged Warren to echo her calls for Twitter to ban Trump from the platform. It was a frivolous exchange with the primary’s emerging front-runner, underscoring Harris’s decline as a potential challenger.

Meanwhile, Warren has co-opted Medicare for All, a Sanders proposal, as her signature policy. Through her command of the issue, Warren means to render Sanders redundant, and she’s succeeding. But Sanders still enjoys double-digit support in most polls, an indispensable role in the debates, and quarterly fundraising totals that exceed those of Warren, Biden, and every other Democrat in contention. Sanders heads into the earliest statewide contests in 2020 with advantages that may well correct his course toward the nomination. He is, after all, the only candidate to have authored a Medicare for All bill in Congress.

The front-runners—Biden, Sanders, and Warren—have dominated the race with their discussion on health care; Sanders and Warren by promoting Medicare for All, and Biden by defending Obamacare. Buttigieg and Minnesota Senator Amy Klobuchar have emerged as dissenting voices to Sanders’s and Warren’s health care proposal. Together, the five have simplified an otherwise crowded contest. Sanders and Warren hope to establish a universal health insurance program to supersede Obamacare while abolishing private insurance options. Biden and his fellow moderates, Buttigieg and Klobuchar, wish to expand Obamacare coverage through a public option while resisting left-wing agitation for a single-payer health care system. “At least Bernie’s being honest here and saying how he’s going to pay for this and that taxes are going to go up,” Klobuchar said in the most recent debate. “I’m sorry, Elizabeth, but you have not said that, and I think we owe it to the American people to tell them where we’re going to send the invoice.”

The debates have all run long (about three hours each), and they’ve all been overcrowded with quixotic moderates, such as Colorado Senator Michael Bennet, and novelty candidates, such as New York businessman Andrew Yang. But the candidates and the moderators have all struggled to host a more comprehensive referendum on the party’s governing agenda. Harris pestered Warren about Trump’s Twitter account, Tulsi Gabbard challenged Warren to oppose further U.S. military intervention in Syria, and Beto O’Rourke challenged Warren, Buttigieg, and everyone else on stage to support mandatory buyback programs for assault weapons. But they’ve all failed to reset the primary season’s prevailing obsession. Buttigieg and Klobuchar are hardly more likely than Harris and Gabbard to win the Democratic presidential nomination next year. But they have at least learned the lesson that Sanders and Warren have utilized to far greater effect: Medicare for All is the future of the party, if not yet the law of the land.