It’s about to get ugly between Democrats on health care

Kamala Harris

Sen. Kamala Harris wants to transform Medicare into a universal health care program while still preserving a central role for private insurers. | Darron Cummings/AP Photo

Democratic presidential candidates are primed for an all-out brawl over health care across two nights of debates that could reveal how far the party will push to again overhaul the nation’s health care system.

First up, Sens. Bernie Sanders and Elizabeth Warren will vie Tuesday for a progressive base enamored with single-payer health care. But it’s the Wednesday debate that’s set to offer the starker contrast, with former Vice President Joe Biden advocating a more incremental plan that pulls the party back from its leftward lurch while Sen. Kamala Harris promotes her new twist on “Medicare for All.”

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That new universal health plan, which Harris dropped on the eve of the debates, could upend the dynamics of an issue that’s energized Democratic voters — but one that more moderate Democrats worry will hurt the party’s shot at defeating President Donald Trump.

“Labels mean a lot,” said Sen. Doug Jones of Alabama, one of the most vulnerable Democrats facing reelection next year. “People are very concerned about a so-called Medicare for All plan. And those people that have private insurance, they sure want to keep it.”

Here’s how the candidates break down on health care:

New version, same Medicare for All brand

The so-called KamalaCare proposal, which immediately drew fire from the left and right, aims to split the difference between die-hard progressives and cautious moderates, offering a clear path to universal coverage without completely dismantling broad swaths of the U.S. health system.

Harris now is placing herself firmly in the Medicare for All camp popular with the party’s liberal base, ending weeks of speculation about where the California lawmaker falls on the spectrum of 2020 candidates.

Yet even as she aligns herself with the Democratic left, Harris has sought to define herself as a singular figure on health care, touting a proposal that accomplishes the aims promised by avowed progressives Sanders and Warren with less of the disruption that’s sparked skepticism within the broader party.

Harris wants to transform Medicare into a universal health care program while still preserving a central role for private insurers. Americans could immediately buy into the new benefit-rich plan overseen by Medicare, but the new scheme would phase in over a decade, far longer than the transitions envisioned by Medicare for All proponents lined up behind Sanders.

The result is a plan with a little bit for everyone, Harris is hoping. “Let’s not lose sight that we have a Medicare system that’s already working,” she wrote on Monday. “Now, let’s expand it to all Americans and give everyone access to comprehensive health care.”

The ‘One True Medicare for All’ theory

That kumbaya moment, though, hasn’t yet arrived. Democratic rivals laid siege to Harris over her plan over the last 24 hours, alternately blasting it as too timid and too ambitious. The blowback offered a clear view of the stakes that winning voters’ trust on health care could play in sorting the crowded 2020 field.

“You can call it anything you want, but you can’t call that plan Medicare for All,” the Sanders campaign blasted out Tuesday.

For Sanders, those broadsides are aimed both at deflating a close competitor and establishing ownership over a concept that has fueled his meteoric rise as a darling of the left and a top-tier 2020 contender.

Sanders has insisted that the only universal coverage plan worth passing is a single-payer plan that effectively eliminates private insurance in favor of giving all Americans government-funded care. Sanders’ Medicare for All legislation — which was endorsed in the Senate by Harris and three other 2020 candidates — would grant generous benefits with no premiums or copays, while eliminating the private sector players that backers argue is driving up health care costs.

Some early analyses show that health care spending could fall under Sanders’ plan compared with its current trajectory. And single-payer advocates, who also include longshots like New York City Mayor Bill de Blasio and Andrew Yang, argue that beyond the dollars and cents, free health coverage is a moral obligation.

“The problem with the current health system: it is governed by corporate greed,” said Faiz Shakir, Sanders’ campaign manager. “You have private insurance companies who deny care to people who need it most.”

But the overhaul would also come with far higher taxes and the eradication of employer-sponsored coverage within four years, a change that critics like Pete Buttigieg and Sen. Amy Klobuchar have characterized as politically unrealistic and unpalatable.

“These are things that are questionable on their merits,” Buttigieg said earlier this month of Medicare for All and other far-left issues prioritized by Sanders.

The ACA is the way

That’s a sentiment shared by most of the Democratic field, albeit one that’s so far failed to drive significant support to candidates outside of Biden. While Sanders and Warren court the left, most 2020 candidates are tacking to the middle in search of a center-left coalition that would rather build on the Affordable Care Act. Biden is largely expected to lead that charge on-stage on Wednesday, after his campaign criticized Harris’ new plan as a “have-it-every-which-way approach.”

The former vice president himself has largely latched on to the Obama administration’s health care legacy, vowing to preserve the ACA and expand it through a public option. Democrats across the ideological spectrum have supported the public option — including those who’d prefer a more sweeping single-payer approach — and it plays into the party’s efforts in Congress to keep the health care debate focused largely on Republican efforts to tear down the law.

“Obviously you’re going to have different ideas about how to best strengthen our health care system,” said Sen. Chris Van Hollen, who ran the Democratic Senatorial Campaign Committee during the 2018 cycle. “It’s important to not lose sight of the major fault line here, which is you’ve got President Trump trying to use the courts to dismantle important protections on health care.”

A new Kaiser Family Foundation poll released Tuesday appeared to boost that view, with 55 percent of the public supporting ideas for expanding the ACA against just 39 percent favoring Medicare for All.

Yet with few other moderate Democrats gaining momentum on the campaign trail, that’s a stance that could make top-tier contenders like Biden and Buttigieg prime targets across a pair of debates likely to be defined not just by the strength of the candidates’ ideas on a passionate topic like health care, but the force of the rhetoric behind them.