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Democrats Debate Health Care Policy


The entry of Bernie Sanders into the presidential race highlights a Democratic policy debate - one that Sanders himself framed four years ago. NPR's Danielle Kurtzleben reports.

DANIELLE KURTZLEBEN, BYLINE: Democratic primary voters are hearing echoes from 2015.


BERNIE SANDERS: In my view, we must move forward toward a "Medicare-for-all," single-payer program.


KURTZLEBEN: Not just because Bernie Sanders is back, but because one of his signature policies never left. Since he first ran for president, "Medicare-for-all" has become a mainstream Democratic proposal. Now presidential candidates are trying to figure out how to position themselves around it. New Jersey Senator Cory Booker has stressed that he thinks private insurers should still have a role.


CORY BOOKER: Even countries that have vast access to publicly offered health care still have private health care.

KURTZLEBEN: Minnesota Senator Amy Klobuchar says "Medicare-for-all" is a possibility in the long term. But for now, she wants to let people buy into Medicaid.


AMY KLOBUCHAR: So what we need is to expand coverage so that people can have a choice for a public option. And that's a start, all right?

KURTZLEBEN: Ohio Senator Sherrod Brown, who's still debating a run, also wants a sort of public option but only for people above age 50.


SHERROD BROWN: I think "Medicare-for-all" will take a while, and it's difficult.

KURTZLEBEN: Long story short, in a huge Democratic presidential field, health care is the first issue where candidates are really differentiating themselves. But they also face a problem. Getting into the details can turn voters off.

LARRY LEVITT: Health reform is always more popular as a bumper sticker than as a piece of legislation.

KURTZLEBEN: Larry Levitt is senior vice president for health reform at the Kaiser Family Foundation. This bumper sticker idea applies to any big health care overhaul, he says, whether it's Obamacare or repealing Obamacare or, now, "Medicare-for-all."

LEVITT: There's a huge political benefit for candidates to be in favor of the idea of "Medicare-for-all" in a primary. But the more the details get filled in, the less popular that idea will be.

KURTZLEBEN: For example, polling shows that nearly 7 in 10 Americans like "Medicare-for-all" if they hear it will eliminate premiums and out-of-pocket costs. But that support drops to around 4 in 10 if people hear it will mean higher taxes. Both of those things could be true of a hypothetical "Medicare-for-all" system. But trying to sell the good with the bad on the campaign trail, especially this early, is tough, which is why staying broad might be a smart move, says Nadeam Elshami, former chief of staff to House Speaker Nancy Pelosi.

NADEAM ELSHAMI: It's OK for a candidate to say, look, this is generally what I believe in; but I'm willing to hear first, and then get into specifics later after I have a deeper discussion of this issue.

KURTZLEBEN: But even this early, President Trump has used the debate over "Medicare-for-all" to paint Democrats as extreme. Republican strategist Michael Steel advised Jeb Bush's presidential campaign.

MICHAEL STEEL: It's a surprising development that 10 years after the passage of the Affordable Care Act and after a massive political backlash against it and a huge effort to defend it, Democrats are immediately swerving so hard to an even greater government role for health care.

KURTZLEBEN: For now, the debate is around health care. But a similar sort of calculation will likely underpin many more Democratic policy debates ahead of 2020, weighing sweeping, progressive ideas that the president could try to label as socialist against incremental policies that might not excite liberal voters. And deciding which choice is most likely to get a Democrat into office. Danielle Kurtzleben, NPR News, Washington.

(SOUNDBITE OF BEASTIE BOYS SONG "B FOR MY NAME") Transcript provided by NPR, Copyright NPR.

Danielle Kurtzleben is a political correspondent assigned to NPR's Washington Desk. She appears on NPR shows, writes for the web, and is a regular on The NPR Politics Podcast. She is covering the 2020 presidential election, with particular focuses on on economic policy and gender politics.