By Sahil Kapur/Washington
Joe Biden and Bernie Sanders are engaged in open warfare over healthcare that could harden party divisions and play into the hands of President Donald Trump.
The tension points to a broader power struggle in Washington and on the campaign trail that pits long-dominant moderates like Biden against an insurgent wing led by Sanders and Elizabeth Warren. But a prolonged battle risks entrenching bitterness between the factions that threatens party unity heading into the general election.
Many prominent Democrats fear that backing an end to private health insurance means defeat in the presidential race and the competitive districts that won the party a House majority in 2018. They prefer more modest legislation to expand government-run insurance options.
Biden favours that approach, calling for largely preserving the popular Obamacare while adding a “public option” that would compete with private insurers. Sanders, a Vermont senator and the chief architect of a Medicare for All plan that would cover everybody under a single government plan, wants to replace the 2010 law.
Aimee Allison, who runs She the People, an activist group that seeks to elevate women of colour and recently hosted a Democratic presidential forum, said young and minorities are eager for change.
“The Democratic Party leadership is more concerned about moderate to conservative Democratic voters, who are a shrinking and less reliable part of the party base, than they are about people of colour, women of colour, younger voters who are inspired by these kinds of ideas,” Allison said.
“That decision led to the loss in 2016,” she said. “There were plenty of black voters who could be inspired to vote and weren’t – and that’s why we lost.”
The split extends far beyond healthcare. Democrats also differ on how aggressively to tackle climate change and whether to support mass cancellation of student debt.
Dan Pfeiffer, a former senior adviser to president Barack Obama, said the differences among Democrats reflect meaningful policy disagreements rather than just political calculations.
“Bernie Sanders should be applauded for pushing the debate” about how bold to be, Pfeiffer said in an e-mail. “But I do think some of the opposition among the candidates to Sanders’ version is about policy as much as politics.”
The healthcare debate grew heated earlier this week when Biden, who as vice-president helped steer the Affordable Care Act, or Obamacare, through Congress, told voters that the “Medicare For All Act” authored by Sanders “means getting rid of Obamacare – and I’m not for that.” He said the bill would end private insurance and ensure that “Medicare goes away as you know it.”
Sanders responded by accusing Biden of “fear-mongering” and parroting the “lies” of Trump and the insurance industry. His campaign website posted a “who said it” quiz on healthcare mocking Biden as being aligned with Senate Majority Leader Mitch McConnell and Trump.
Biden argues that Medicare for All would cancel plans for the 150mn people on private insurance, and that he’d give them the option to keep their plan. Sanders says adding a public option to Obamacare would be less effective at covering the 27mn uninsured Americans or cutting costs. While a tax increase would be required to pay for single payer, it would be offset by eliminating premiums and out-of-pocket costs, he says.
Biden pressed his argument on Thursday, insisting he wasn’t criticising Sanders but rather conveying what his plan would do.
“Bernie’s completely honest about saying he’s going to raise taxes on the middle class and just straightforward about it,” the former vice-president told reporters in Los Angeles.
A similar power struggle is unfolding in the House of Representatives, where Speaker Nancy Pelosi and moderate Democrats have clashed with the “Squad” of newly elected progressive women – Representatives Ayanna Pressley, Alexandria Ocasio-Cortez, Ilhan Omar and Rashida Tlaib.
The new lawmakers have used their large social media followings to elevate far-reaching ideas, while challenging party leaders to be more tactically aggressive with Trump on issues like immigration and impeachment.
“The Squad – they’re a proxy for the millions of us who want to see a bolder, more progressive set of policies and changes,” Allison said, arguing that limiting the Democratic Party’s vision based on what appears politically possible would prevent new voters from getting engaged and turning out.
Polling on Medicare for All illustrates the party’s dilemma. Surveys indicate that a majority of Americans favour the idea. But support plummets when people are told the programme would eliminate private insurance and rises again when they are told that switching to a government-run plan doesn’t necessarily mean losing their doctors and providers.
Pelosi and other Democratic leaders back Biden’s approach. Sanders’ single-payer plan is cosponsored by 2020 rivals Warren, and Senators Kamala Harris, Cory Booker and Kirsten Gillibrand. Harris says she prefers single payer but has also cosponsored legislation for a public option as a route to extending coverage.
Ocasio-Cortez said Americans she talks to “like their health care, they like their doctor,” but that they aren’t “heartbroken” about the prospect of having to transition off an Aetna or Blue Cross Blue Shield plan.
Trump and his allies have sought to make the Squad the face of the Democratic Party, believing that they alienate moderate voters. House GOP campaign chairman Tom Emmer called the four women the “red army of socialists” at a Christian Science Monitor breakfast for reporters.
The four women are among the 114 cosponsors of the Medicare For All Act in the House, but the legislation has stalled out and is unlikely to be brought to a vote, which suggests that the moderate wing is winning the battle in Washington.
Many prominent Democrats fear that backing an end to private insurance means defeat in the competitive districts that won the party a House majority last fall. They prefer more modest legislation to expand government-run insurance options.
Andy Slavitt, a former acting head of the Centers for Medicare and Medicaid Services under Obama, said Democrats unanimously agree on the goal of universal coverage but differ on how best to get there.
“Primaries are about calling out differences in approach. There should be sufficient oxygen to say how would Joe Biden or Michael Bennet do it versus how would Bernie Sanders do it,” he said in an interview.
Slavitt warned that while a debate was healthy, Democrats shouldn’t lose sight of the ultimate goal.
“It’s important that we don’t get so overwhelmed with the distinctions around ‘how’ that we forget there is a massive gulf between what the visions are,” Slavitt said, “between Democrats and the president’s position to repeal the ACA, make coverage more expensive.” - Tribune News Service
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