Financial Times Europe - 23.09.2019

(Kiana) #1

Monday23 September 2019 ★ FINANCIAL TIMES 3


LAUREN FEDOR— WASHINGTON


While Democrats want the 2020 elec-
tion to be a vote on Donald Trump’s
presidency, so far the party’s presiden-
tial hopefuls have spent most of their
time arguing over an issue that risks
alienatingvoters.
The candidates’ televised debates
have been dominated by sharp disa-
greements over whether “Medicare for
All” — a phrase coined by Vermont
senatorBernieSanders—isthebestway
to reform the expensive and inefficient
UShealthcaresystem.
US census figures published last week
showed that the number of uninsured
Americans rose for the first time in
almost a decade in 2018, to 27.5m. But
while most Democrats agree that all
Americans should have access to
healthcare, the debate over how to
achieve that has confused voters. It has
also given the Republicans a fresh
opportunity to argue that the
Democratic party is moving danger-
ouslytotheleft.
“TheDemocratswanttomake[2020]
a referendum on Trump,” said Kyle
Kondik, managing editor of the non-
partisan Sabato’s Crystal Ball at the
University of Virginia’s Center for
Politics. “These proposals give Republi-
cans a chance to make this election
moreaboutachoice.”
Mr Sanders, 78, a self-described Dem-
ocratic socialist, has spent much of his
career campaigning for the US to adopt
a universal, government-sponsored
healthcare system, similar to Canada’s.


His current plan is driven in part by
polling that shows the overwhelming
popularity of Medicare, a US federal
government programme that provides
health insurance to pensioners and
someyoungerpeoplewithdisabilities.
But his promise to expand Medicare
over four years, effectivelyeliminating
private health insurance, would cost
more than $3tn a year, doubling annual
federal spending and resulting in tax
increasesformanyAmericans.
Mr Sanders argues that families’
healthcare costs would go down, as he
would end out-of-pocket expenses —
including “co-payments” for doctor
visits and “deductibles” that need to be
paidbeforeinsurancekicksin—andcap
prescriptioncostsat$200ayear.
Elizabeth Warren, the senator from
Massachusetts, has largely endorsed Mr
Sanders’ plan. But other candidates,
most notably former vice-presidentJoe
Biden, have attacked the proposals, say-
ing they are too expensive and would
eliminate choice for voters — around
half of Americans have private health
insurancethroughtheiremployers.
MrBidenhasinsteadcalledforan
expansion of the Affordable Care
Act, the sweeping 2010 legislation
that expanded government assist-
ance for people on low incomes and
forbade insurers from denying care
to people with pre-existing medical
conditions. After Mr Trump was
elected, the Republicans sought to
repeal the ACA, but the efforts were
stymied in the Senate, when then-
Republican senator John McCain

voted against the measure. Mr Biden
has proposed introducing a govern-
ment-run “public option”plan to com-
pete with private insurers —something
that resident Barack Obama aban-P
donedaspoliticallytoodifficult.
Other candidates have offered pro-
posals that fall somewhere between Mr
Sanders’ and Mr Biden’s plans, but
which play on the Medicare for All
moniker. Kamala Harris, the senator
from California, would expand Medi-
care but maintain a role for private
insurers under her Medicare for All
plan. Pete Buttigieg, he mayor of Southt
Bend, Indiana, would build on the ACA
with “Medicare for All Who Want It”.
Beto O’Rourke, he former congress-t
man from Texas, would maintain a role
for both the public and private sectors
with“MedicareforAmerica”.
Most US voters are confused. The
latest poll from the independent
Kaiser Family Foundation
found that 55 per cent of
Democratsandindependents
who lean Democratic would

prefer a presidential candidate who
built on the ACA, compared with about
40 per cent who want to replace it with
Medicare for All. But the survey also
foundthat less than halfthink there are
differences between Medicare for All
andagovernment-runpublicoption.
Liz Hamel, director of public opinion
and survey research at the Kaiser Fam-
ily Foundation, said that, at a time of
rising medical and prescription drug
costs, Democratic voters “really do care
about healthcare”, but most “don’t
reallycarehowyougetthere”.
“Your average voter just wants to see
those costs and those prices come
down,”sheadded.“Theywantrelief.”
Ms Hamel said support for Medicare
for All was “very malleable” depending
on the messages voters receive. People
are more likely to back the concept if
they are told it will provide universal
healthcare coverage for all Americans.
But support wanes if they learn rivatep
healthinsurancewouldbeeliminated.
Separate polling by Third Way, a
centrist Democratic think-tank, found

that support for Medicare for All fell as
likely Democratic voters were told
aboutthepotentialcostsandtaxesasso-
ciated with it. Support slipped to just 23
per cent when voters were told that
Medicare for All would give a future
Republican White House or Congress
controloverhealthcareservices,includ-
ingbirthcontrolandaccesstoabortion.
Matt Bennett, co-founder of Third
Way,calledMedicareforAllan“incredi-
bly toxic... political killer” that would
alienate many voters not only in the
Democratic primaries, but also in com-
petitive congressional districts in next
year’sgeneralelection,wheremanyvot-
ers are likely to prefer to keep their
private insurance. “The minute you
start poking holes in Medicare for All,
supportcollapses,”hesaid.
Mr Kondik also cautioned that Medi-
care for All played into Republican
arguments that the Democratic party
had moved too far to the left. Mr Trump
and the Republicans are already saying
the Democrats’ “radical socialist” plans
willharmAmericans.

Democratic fever


over reform of


Medicare risks


alienating voters


Party’s presidential hopefuls generate


confusion in universal healthcare clash


I N T E R N AT I O N A L


Senator Bernie
Sanders, above,
wants universal
government-
sponsored
healthcare.
Below, Senator
Kamala Harris
would expand
Medicare, but
keep role for
private insurers
Mark Wilson/Getty Images

‘Your
average

voter just
wants to see

those costs
and those

prices come
down. They

want relief ’


SEPTEMBER 23 2019 Section:World Time: 9/201922/ - 17:05 User:ian.holdsworth Page Name:WORLD2 USA, Part,Page,Edition:EUR , 3, 1

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