◼ POLITICS Bloomberg Businessweek January 27, 2020
35in 2008 thata stronggroundgamecanmakeall
thedifferenceinIowa,butwithPresidentDonald
Trump’simpeachmenttrialrampingupinthe
Senate,Sanderswillhavetobeabsentforlong
stretches.SowillWarrenandMinnesotaSenator
AmyKlobuchar,givingBidenandButtigiegtherun
ofthestateinthecrucialdaysbeforethecontest.In
a racethisclose,everyhandshakecounts.
ButSandersmaybetoughtodislodge.Hissup-
portseemslesslikelytoyo-yothansomeofhis
rivals’.“Thebiggestthingformeis thathehascon-
sistency,”saidBerlinMenendez,24,a formulation
scientistinIowaCityandcampaignvolunteerwho
wasclutchinga stuffedBernieSandersdollatthe
climaterally.“Thefactis thathehasn’twaveredon
hisbeliefsinallofhisyearsinoffice.”
OnewaySandershaschangedisinhowhe’s
decidedtocompeteforthenomination.In 2016
hechosenottogoafter Clintonaggressively,
famouslydeclaringthathewas“sickofhearing
aboutyourdamnedemails.”Heendeduplosing
IowatoClintonbythetightestofmargins,49.8%to
49.6%,a setbackhenevermanagedtoovercome.
Thistime,he’sleavingnodoubtthatheand
hiscampaignareplayinghardballwithideologi-
caladversariesandalliesalike.DuringtheJan. 14
Democraticdebate,Sandersreprisedanattack
he’sbeenmakingonthetrail,criticizingBiden
overhisIraqWarvoteandscoffingattheformer
vicepresident’sclaimtobe,asa newTVadputsit,
“someonetestedandtrustedaroundtheworld.”
Sanders’scampaignhasalsogoneafterWarren,
a purportedfriendandally,bycirculatinginstruc-
tionstocampaign surrogatestoattackheras
anelitistunabletounifytheparty,a movefirst
reportedbyPolitico.Warrenrespondedbypour-
inggasolineona CNNreportthatSanderstoldher
ina private 2018 meetingthata womancouldn’t
getelectedpresident.Sandersvehementlydenied
thereport.ButWarrenconfirmedit ina public
statementandonthedebatestage,raisingdoubts
aboutSanders’struthfulness.
Thefrostyexchangebetweenthetwoimme-
diatelyafterthedebate—Warrenrefusedtoshake
Sanders’shandand,inaudiolaterreleasedbyCNN,
accusedhimofcallinghera liar—leftnodoubtthat
thistimeSandersis runningtowin.Andthere’sno
reasontobelievehecan’tdoit.�JoshuaGreen,
withEmmaKinery
MichaelBloomberg,founderandmajorityownerof
BloombergLP,BloombergNews’parent,is seekingthe
Democraticpresidentialnomination.
THE BOTTOM LINE While a Sanders victory is nowhere near
assured, his supporters are devoted, and his Iowa campaign is
peaking at just the right time.
UniversalHealth
Care,theSouth
AfricanWay
● The ruling party
is pushing a bill that
would nationalize health
insurance by 2026Ballooning costs that no one seems able to control.
A two-tiered system where the wealthy get more
attention than they need while the poor don’t get
enough. Skyrocketing insurance premiums and
malpractice claims. And now a plan to redeploy
the resources of the country’s top earners to make
health care affordable for the many.
This is South Africa, where the inequities have
for years been an exaggerated version of those in
the U.S. The African National Congress party, which
has led the country for more than 25 years and holds
58% of seats in Parliament, has committed to enact-
ing universal health insurance, outlining the frame-
work in a draft law published in August. Significant
questions remain, including which drugs and ser-
vices will be covered and how the whole thing will
be financed. But with the country’s biggest labor
group behind it, the bill’s fate is clear: South Africa
will soon join the majority of the developed world
in providing some form of nationalized health care.
The grand experiment is a more mature version
of the health-care debate in the U.S., where can-
didatesfortheDemocraticpresidentialnomina-
tionareputtingtheircompetingvisionsforwhat
government-sponsored care should look like before
voters. Senators Elizabeth Warren of Massachusetts
and Bernie Sanders of Vermont propose a universal
version of the existing Medicare program that would
be phased in over several years and replace private
insurance. Others, including former Vice President
Joe Biden and centrist Pete Buttigieg, advocate a
hybrid model that would expand the existing pub-
lic programs but preserve a private option.
For any of these proposals to become law, there
would have to be a dramatic shift to the left, says Bob
Blendon, a Harvard health-policy polling researcher.
Even when Democrats controlled the House, Senate,
and presidency, as they did when the Affordable
Care Act was signed into law in 2010, they couldn’t
get enough support for a public option. “There
would have to be a sea change,” he says.
Politicians and policy experts in South Africa
have wrangled for years over what to do about
the country’s fractured, two-tiered system. Now,
however, “we’re approaching an affordability cri-
sis,” says Andrew Gray, a pharmacy researcher at
the University of KwaZulu-Natal who backs the● Proportion of South
Africa’s doctors serving
the 16% of its population
with private insurance70%