On Wednesday, nearly four years after launching his first unlikely presidential campaign, Senator Bernie Sanders unveiled a new version of one of his signature proposals: Medicare for All. The bill, which has 14 co-sponsors, outlines a universal, government-run healthcare program that would cover hospital care and preventative services, as well as dental and vision services. It would end employer-provided insurance plans, but the Veterans Health Administration and the Indian Health Services would continue to exist as stand-alone, government-run systems, according to Vox. Americans could still choose their own physicians.
Overall, the plan differs little from Sanders’s previous M4A legislation, with one notable exception: It adds a long-term care benefit, which would cover at-home care for people with disabilities. In this respect, it resembles the House version of the M4A introduced by Representative Pramila Jayapal in February.
The overlap illustrates a recurring concern about Sanders’s second presidential bid: that he’ll be a victim of his own success. Though Medicare for All did not originate with Sanders, the senator took it mainstream during his 2016 presidential campaign, and he owes his national profile in part to its popularity. This time, however, Medicare for All isn’t a fringe idea, and Sanders isn’t a fringe candidate, but a frontrunner. His policy positions — including Medicare for All — gained Democratic supporters over the last few years, and they’ve proven to be unexpectedly durable. Now several Democratic 2020 candidates are running on Medicare for All. In fact, four of them — Senators Cory Booker, Kirsten Gillibrand, Kamala Harris, and Elizabeth Warren — co-sponsored Wednesday’s bill. In theory, that could make it difficult for Sanders to distinguish himself from other leading candidates.
Since Sanders has already set the tone of the Democratic primary, on health-care policy, at least, the question now is whether he can set the pace — whether his more immediate vision of change will win out over incrementalist alternatives. Democrats who say they support Medicare for All in principle often favor less generous versions of it in practice; as CNN notes, the candidates who co-sponsored the legislation have all signaled their willingness to consider compromise options. Booker, in a radio interview on Wednesday, described Medicare for All as an “ideal” and said that, while he thinks that the “best way” to ensure public access to affordable health care would be to design a Medicare for All system, “anybody who says those words ‘Medicare for All’ who’s running for president, the next thing out of their mouth should be talking to people about, in a split Congress, what are you going to do in your first year to make healthcare more accessible and affordable?”
Sanders does have some advantages over Booker and other candidates who are open to more incremental health care reform. First, his public image is so linked to M4A that voters may be inclined to trust his approach over others’ policy proposals. Second, the problems with maintaining America’s privatized system are vividly, and often painfully, apparent. Americans are rationing insulin because of the expense. Even having a healthy childbirth can be a luxury. As Axios reported, the U.S. is the most expensive nation in the world in which to give birth; the cost is much lower in nations with a version of single-payer healthcare in place. In such dramatically unequal circumstances, voters may see the urgency of Sanders’s healthcare vision as a necessity, not merely an ideal.