Health care was a driving issue in the 2018 election, which saw Democrats make significant gains in Iowa and across the country.
It remains a top issue for voters interested in the 2020 Democratic presidential primary.
And it is an issue that displays differences between those Democrats in the expansive primary field.
The most clear fault line in the Democratic primary debate is some version of Medicare-for-all, a de facto government-operated health care system, versus expansion of the current health care system plus some version of a public health insurance option.
Generally, Medicare-for-all proposals would place all Americans into a government-operated health care program similar to Medicare. Private insurance would essentially be eliminated, although under some plans those companies would be able to offer supplementary insurance plans.
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Medicare-for-all proposals are expensive: roughly $30 trillion over a decade, according to myriad estimates.
Candidates who propose Medicare-for-all — like U.S. senators Bernie Sanders and Elizabeth Warren — say it's needed to cut medical costs for Americans. Under most Medicare-for-all proposals, co-pays and deductibles would be eliminated.
Americans likely would be subject to an increase in taxes to help fund such a program. Proponents say Americans would save money from reduced health care costs and that would more than offset any tax increase.
More moderate Democratic candidates — like former vice president Joe Biden and former South Bend, Indiana, mayor Pete Buttigieg — are proposing a so-called public option. Under those proposals, Americans would be offered the choice to retain their private insurance or buy into a government-run health care program similar to Medicare.
Buttigieg has coined his public option proposal “Medicare for all who want it.”
Proponents of a public option say it would build on the current health care law signed by former President Barack Obama — with Biden as his VP — and that it allows Americans a choice.
Former Vice President Joe Biden
- Health-care priority is to rebuild and protect the Affordable Care Act, also known as Obamacare.
- Plan would cost about $750 million to subsidize a Medicare option.
- Would allow people to keep private insurance policies, expand health care coverage for low-income families, and expand access to health care when it is most needed.
- Would lower drug prices by forcing pharmaceutical companies to negotiate with Medicare and allow customers to buy drugs from other countries to expand competition
Vermont Sen. Bernie Sanders
- Co-wrote 2019 Medicare For All bill, which would create a single-payer, national health insurance program to provide everyone in America with free comprehensive health care coverage.
- The bill's key points focus on no networks, no premiums, no deductibles, no co-pays and no surprise bills.
- Medicare coverage would be expanded and improved to include dental, hearing, vision, long-term care, in-patient and out-patient services, mental health and substance abuse treatment, reproductive and maternity care, and prescription drugs.
- Would make sure no one pays more than $200 a year for medicine by capping what Americans pay for prescription drugs under Medicare for All.
Mayor Pete Buttigieg, South Bend, Ind.
- Calls his health care plan “Medicare for All Who Want It.” It would include a “public option" that would start a long-term “glide path” to single-payer without eliminating private insurance.
- Government option would automatically enroll the uninsured, with others having the option to join.
- Those who choose not to enroll in coverage could be forced to pay a premium. Plan caps the cost of the premium at 8.5% of income.
- Plan would cost an estimated $1.5 trillion.
Mass. Sen. Elizabeth Warren
- Would transition American health care to Medicare For All in the next four years.
- Would use executive actions to lower prices of several pharmaceutical drugs held under patent.
- In time, would expand Medicare to everyone over 50.
- Estimates the plan would cost $20.5 trillion over a decade. Would fund plan through existing taxes on businesses as well as new taxes, including a wealth tax on millionaires and billionaires.
Minn. Sen. Amy Klobuchar
- Supports adding a public option to the Affordable Care Act in order to expand Medicaid and Medicare.
- Would work to bring down pharmaceutical prices.
- Supports lowering the Medicare age to 50.
N.J. Sen. Cory Booker
- Supports Medicare for All in addition to universal paid family and medical leave.
- Would lower prescription drug costs by allowing Medicare to negotiate lower prices and import drugs from Canada and other countries.
- Would take patents away from drug companies that sell the same medicine for less in other countries.
- Would lower the Medicare age to 50.
Graham Ambrose is the Iowa politics reporter for the Quad-City Times.