Democratic presidential candidate Joe Biden smiles as Sen. Bernie Sanders (I-Vt.) (L) looks on during the Democratic presidential primary debate at the Charleston Gaillard Center in February 2020 in Charleston, S.C. | Win McNamee/Getty Images
FACE/OFF — During the 2020 presidential campaign, Joe Biden and Bernie Sanders argued — and argued — over universal health care.
Sanders wanted Medicare for All, a government-financed plan that would cover everyone. Biden campaigned on making the Affordable Care Act passed by President Barack Obama more robust, with the goal of putting health care within everyone’s reach.
One surprising development in the seemingly endless negotiations over President Biden’s Build Back Better Act is that Biden and Sanders have sort of swapped goals, at least for this particular debate over health policy.
They are each still on the side of Medicare and Obamacare, respectively. But Biden now is trying harder to expand the number of people who get health care. And Sanders is trying harder to improve coverage for people who already have it.
A debate over what Congress can get done is more constrained than the idealistic rhetoric of a Democratic presidential primary. In 2021 — under the reality of a 50-50 Senate — single-payer or Medicare for All are not on the table. Nor is the Biden-favored public option.
The Democrats instead have been horse trading over whether dental, hearing and vision coverage should be added to Medicare; how long to extend expanded Obamacare subsidies; and how to close the Medicaid gap that leaves very poor people in a dozen anti-Obamacare states without any insurance coverage at all. In the framework Biden released this morning, ACA subsidies are in, there’s a Medicaid workaround, and Medicare would add benefits for hearing — but not for dental and vision.
Some of this is to be expected: After Biden won the 2020 primary, Democrats papered over their differences on health care and accepted that change would be incremental with the Affordable Care Act as the foundation, at least for now.
But as the endless dealmaking around the reconciliation bill shows, Democrats don’t agree on what “incremental” means, what’s the best next step toward universal coverage.
Is it shoring up the Affordable Care Act by expanding subsidies for millions and covering the poor whose states left them out of Medicaid, as Biden (and House Speaker Nancy Pelosi) seem to believe?
Or is it making Medicare — America’s socialized medicine for seniors — even …….