If there’s one thing Joe Biden wants people to know about his new health care plan, it’s this: It is not Medicare for All. “Read the plan,” he told reporters about his proposal, which would bolster Obamacare and add a public option. “I’m not criticizing Bernie. It’s just everybody should know the Medicare plan that will replace existing Medicare, it’s not the same plan. It doesn’t mean it’s not good or bad or different, but it’s different. It’s not the same plan.”
Driving home the point, Biden has spent much of the week targeting Sanders, making the case that Medicare for All is both a pipe dream and, apparently, an affront to Barack Obama’s legacy. “I knew the Republicans would do everything in their power to repeal Obamacare,” he said in a promotional video timed to the release of his health care plan. “They still are. But I’m surprised that so many Democrats are running on getting rid of it.”
Sanders himself has fired back a number of times, pointing out factual inaccuracies in Biden’s critique—including his delusory claim that a transition to Medicare for All would create a “hiatus” in health coverage. “I am disappointed, I have to say, in Joe, who is a friend of mine, really distorting what Medicare for All is about,” Sanders told The New York Times on Wednesday. “And unfortunately, he is sounding like Donald Trump. He is sounding like the health care industry in that regard.” In other statements, Sanders has argued that Biden’s plan is aligned with “corporate greed,” and that it echoes what “the insurance companies, and the pharmaceutical industries, Republicans do: ignoring the fact that people will save money on their health care because they will no longer have to pay premiums or out-of-pocket expenses.”
“They will no longer have high deductibles and high co-payments,” Sanders added.
It was arguably the first broad policy disagreement between leading candidates in the 2020 Democratic primary, though it was largely overshadowed by coverage of Donald Trump’s racist attacks on four Democratic members of Congress. For Biden, it was also meant as something of a reset. He had tried to fly above the fray through the first few months of the primary; now, with the release of the plan, he was getting down to business.
Biden’s modest health care proposal is clearly intended to underline what he believes are his strengths. It is a clear, unrepentant extension of the centerpiece of Barack Obama’s legacy, the Affordable Care Act. It is a plan designed to remind voters that Biden once worked for a guy that nearly every Democratic voter holds in high esteem—which is still what likely supports the former veep’s frontrunner status. It is also, perhaps more importantly, designed to reassure skittish Democrats. While most of the field is following Sanders’s lead and embracing universal health care—and, in many instances, advocating the phaseout of private health insurance—Biden is betting that small fixes to the status quo make for the best politics.
“Under the proposal I have, you would be able to keep your insurance with your employer if your employer is still prepared to pay for the insurance,” Biden said, echoing Obama’s speeches on the Affordable Care Act. This 2020 proposal would include a buy-in to a public option that resembles Medicare, and it would also use tax increases on the wealthy to expand coverage—though Biden’s plan, unlike Medicare for All, would still leave millions without any insurance. The former vice president has defended this on the stump by arguing that an incremental approach is best, calling a public option “the quickest ... most rational way to get universal coverage.” Biden has also labeled Medicare for All “risky.”
An incremental approach was pitched as an instantly helpful and politically pragmatic path toward universal coverage when Democrats first took up health care reform back in 2009. But, while the Affordable Care Act has increased insurance coverage, no one would argue the law directly paves the way toward universal health care. Instead of pushing to expand its remit, Democrats have spent the last decade fighting to protect it from waves of attacks from the right.
Biden’s health care plan is yet another example of the kind of thinking that has plagued Democrats over the past several decades. Rather than presenting a bold vision for the country, Biden is promising a steady hand guiding a slightly improved version of what people already have. It’s supposed to be a pitch to voters in the party’s moderate and conservative wings—but it is perhaps more identifiably an appeal to many donors who are concerned about Democrats’ evolution leftward and growing distaste for corporate power.
It’s a “dream small” plan, though—one that punts on the question of remaking America’s institutions, many of which need a substantial overhaul. It’s also one that seems designed, perhaps intentionally, to make the case that large-scale change is both impossible and politically unwise. It’s a message targeted at supporters of Sanders, and all those who have made the case that the Democratic Party needs to think bigger if it wants to win elections.
Biden’s counterpoint, it appears, is aimed squarely at an unquantified number of ill-defined centrists. “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 color, women of color, younger voters who are inspired by these kinds of ideas,” Aimee Allison, founder and president of the political advocacy group She the People, told Bloomberg. “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.”
Those seem words Biden does not want to hear. Instead, struggling in the wake of the first debate, the longtime public servant has hit upon a different message: Sure, other candidates might inspire people to hope for more and reimagine what this country can do, but that’s too much. One might even say it’s “audacious.”