Joe Biden is making a very big bet on the status quo.
That’s true for his 2020 presidential campaign generally (his argument is that Donald Trump’s election is a fever dream from which the GOP — and the country — will awake) but especially true on the issue that has proven decisive in a majority of elections in recent memory: Health care.
On Monday, Biden rolled out his health care plan which, while it does many new-ish things, is best described as Obamacare Plus.
Biden’s plan takes the Affordable Care Act as its foundational principle and builds from there. So there is more money to lower the cost of purchasing insurance — and a public option similar to Medicare for those who want it. But there is not much that’s radical in the Biden proposal, nothing coming anywhere close to the “Medicare for All” proposal, which would eliminate the private insurance industry (and the ACA) in favor of a health care system run entirely by the government, supported by at least two of his main rivals for the 2020 Democratic nod.
“We should not be starting from scratch,” Biden said in New Hampshire on Sunday. “We should be building from what we have. There’s no time to wait.” And in a video released Monday morning to accompany his health care proposal, Biden noted that in the first Democratic debate last month he made clear he opposed getting rid of private health insurance.
“I believe we have to protect and build on Obamacare,” Biden said in the video. “I understand the appeal of ‘Medicare for All’ but folks supporting it should be clear that it means getting rid of Obamacare. And I’m not for that.”
Within hours, Vermont Sen. Bernie Sanders, the author the “Medicare for All” legislation, which is supported by Sens. Elizabeth Warren (Mass.) and Kamala Harris (Calif.) among others in the 2020 race, hit back at Biden’s plan. Tweeted Sanders:
“I fought to improve and pass Obamacare. I traveled all over the country to fight the repeal of Obamacare. But I will not be deterred from ending the corporate greed that creates dysfunction in our health care system. We must pass Medicare for All.”
(The Sanders tweet included a video of Barack Obama calling Medicare for All a “good new idea.”)
Biden’s willingness to stand up against the Medicare for All forces is a gamble, yes, but it is a calculated one based on a bevy of polling that seems to suggest the former vice president’s positioning on the issue is the most popular approach.
A recent poll from the Kaiser Family Foundation, which has been tracking views of the ACA for years now, affirms the Biden position. The ACA is viewed favorably by 46% of the country while 40% have an unfavorable view of the law. (Obamacare’s favorable numbers have outpaced its unfavorable ones since almost the minute the former president left office.) Among Democrats, the law is even more popular; 79% view it favorably while just 12% regard it unfavorably.
Kaiser also asked Democratic and Democratic-leaning respondents what specific part of the health care debate they wanted the 2020 candidates to address in the first debates of the presidential campaign. (The poll came out last month, just before the two-night extravaganza in Miami.) More than a quarter — 28% — said that lowering the cost of health care was what they wanted to hear from the candidates most about. About half that number (15%) said they wanted to hear the candidates discuss implementing a single-payer or Medicare for All system.
Importantly — and potentially problematically for Biden — that question broke down along ideological lines. Among self-identified liberals, 23% said they wanted to hear more from the candidates about implementing Medicare for All. That number was just 9% among moderates.
The coming (or maybe it’s already here) health care fight in the 2020 Democratic race is indicative of the broader scuffle within the party between incremental and radical change. Biden has proudly embraced the view that Trump’s presidency requires not a blowing up of the political system but rather a reinvestment in it by good-hearted public servants. Sanders and Warren (and, sort of, Harris) believe that Trump’s presidency is a feature, not a glitch of Republican politics — and that the only response to these four years of Trump is to destroy the very political system that allowed him to be elected president.
Biden’s message is one that Republicans fear could lure many of their voters — already wary of Trump — in a general election. And almost all general election polling done in the race suggest the former vice president is not only the strongest potential Democratic nominee against the incumbent but would start that race with a statistically significant lead. But his problem may be — emphasis on may be — that in a Democratic primary, particularly in the year 2020 and with Donald Trump sitting in the White House, the party’s most active voters want to support candidates advocating for massive, structural change rather than incremental fixes.
Biden’s belief is that there won’t be enough of those big change voters to cancel out the incrementalists — on health care or in the race more generally. Like I said, it’s a big gamble — and one that if he bets wrong could well cost him the nomination.