One of the more controversial issues surrounding this year’s Democratic Party platform has been whether to include a plank supporting the idea of Medicare for All — an intraparty debate that seems unlikely to be resolved any time soon.
For decades, a program like Medicare for All was included in Democratic platforms up until 1980, explained Ron Birnbaum, MD, a Los Angeles dermatologist and delegate for Sen. Bernie Sanders (I-Vt.) at this year’s Democratic National Convention. “It’s a core issue for a lot of people in the world of Bernie Sanders,” he said in a phone interview, “so people were upset and flummoxed that the starting point of the Biden camp was not using those words in the platform.”
The current 92-page draft platform mentions Medicare for All only once: “We are proud our party welcomes advocates who want to build on and strengthen the Affordable Care Act and those who support a Medicare for All approach; all are critical to ensuring that health care is a human right.” The platform advocates instead for a “public option” approach, in which “we will give all Americans the choice to select a high-quality, affordable public option through the Affordable Care Act marketplace. The public option will provide at least one plan choice without deductibles; will be administered by CMS [the Centers for Medicare & Medicaid Services], not private companies; and will cover all primary care without any co-payments and control costs for other treatments by negotiating prices with doctors and hospitals, just like Medicare does on behalf of older people.”
“Everyone will be eligible to choose the public option or another Affordable Care Act marketplace plan,” the platform continues. “The lowest-income Americans, including more than four million adults who should be eligible for Medicaid but who live in states where Republican governors have refused to expand the program, will be automatically enrolled in the public option without premiums; they may opt out at any time. And we will enable millions of older workers to choose between their employer-provided plans, the public option, or enrolling in Medicare when they turn 60, instead of having to wait until they are 65. Democrats are categorically opposed to raising the Medicare retirement age.”
Birnbaum is also upset that the platform doesn’t encourage states to experiment with their own versions of single-payer healthcare, which would require special waivers from federal programs like Medicare and Medicaid. “[Rep.] Ro Khanna [D-Calif.], our delegation chair … is principal sponsor of H.R. 5010, a state-based universal healthcare act, designed to help individual states do Medicare for All,” Birnbaum said. “So maybe if you don’t want to do it nationwide, but a state like California that Bernie won, maybe we want to do it here, and maybe it would be cool to support us, but they blocked that too.” He noted that Canada’s single-payer healthcare system started with a single Canadian province, Saskatchewan, implementing its own single-payer system.
The platform does nod to that scenario. “Democrats will also empower the states, as laboratories of democracy, to use Affordable Care Act innovation waivers to develop locally tailored approaches to health coverage, including by removing barriers to states that seek to experiment with statewide universal healthcare approaches.” But the term “universal healthcare” is too vague, Birnbaum said in an email. “It is meant to avoid the more clear terms that include ‘Medicare for All’ and ‘single-payer’ — words that I believe Vice President Biden thinks are toxic to his election chances.”
The Sanders delegates had proposed stronger language that included those words, and “we all felt that the rejection of the stronger language was a signal: whether for political expediency or policy reasons, it was a deliberate rejection of Medicare for All (or single payer), in this case at the state level,” he said.
Of the nearly 4,000 delegates at the convention, more than 800 have pledged to vote against the platform because of its treatment of Medicare for All, according to Cheng-Sim Lim, a filmmaker and a Sanders delegate from Los Angeles. “Odds are we won’t have enough votes to vote down the current platform, but it is a strong enough showing of the discontent with the fact that Medicare for All — especially in the time of COVID — is missing from the platform; it’s a statement about our values as a party,” she said in a phone interview. “We’re drawing a line in the sand.”
Other delegates favor the party’s universal coverage approach. “I’d love to see everyone covered in a healthcare plan … but the reality of it is, in order for people to have this, everybody’s got to buy into it,” said Peggy Chase, RN, EdD, a Biden delegate and a New York state legislator from Onondaga County. “You can’t be shoving this down somebody’s throat.” She added that Biden is on target with the idea that “we need to work toward something that will cover everyone, but for people who don’t want to give up their insurance, we want to leave them alone. One size does not fit everybody.”
It would be “nice if you could walk into the doctor’s office and be taken care of and not worry about anything financial, but we’re a long way from that and we’re not going to get there overnight,” she said. “We’ve got to work towards something that would be perfect, but perfect isn’t the same for everybody. My hope is that we get something that’s reasonable, that everybody would be able to easily access healthcare.”
Votes on the platform are due by Aug. 15 and the result will be announced at the convention next week, a Democratic Party spokesperson said in an email. The spokesperson did not comment on the disagreement over the Medicare for All plank.
Last Updated August 13, 2020