Only Two Democrats Tonight Said They Would Support Single-Payer Health Care. That’s Telling.

Bill de Blasio, Tim Ryan, Julian Castro, Cory Booker, Elizabeth Warren, Beto O'Rourke, and Amy Klobuchar on the debate stage.
The Democratic contenders, Night One. Joe Raedle/Getty Images

When the candidates at Wednesday night’s Democratic presidential debate were asked whether they would be willing to abolish private health insurance and replace it with a government-run plan, only two raised their hands: New York Mayor Bill de Blasio and, much more importantly, Sen. Elizabeth Warren.

Only Bill de Blasio and Elizabeth Warren raise their hands in the row of debaters.

Warren didn’t just raise her arm. She shot it into the air, assertively and without hesitation. This was a bit of a surprise. Whether or not Democrats should aim to eliminate private insurance entirely, as Sen. Bernie Sanders has proposed to do with his “Medicare for All” plan, or allow Americans to keep their employer-based plans while offering a public option, is the single most sensitive health care question in the campaign. And in past interviews, Warren—who otherwise has run hard to the left—has waffled on it, offering vague statements about how there are “lots of paths” to Medicare for All, whatever that meant. But this time, she left zero ambiguity in her answer. “Yes, I’m with Bernie on Medicare for All,” Warren said, before launching into a disquisition on medical costs, bankruptcies, and the perfidy of insurance companies. “Health care is a basic human right, and I will fight for basic human rights,” she concluded.

It’s not hard to see why Warren has decided to join Sanders on this issue. The senator is running for the hearts and minds of the left by combining wonkishness and truly populist politics. But until now, Sanders has continued to outflank her on health care. And her squishiness on the topic—Democrats’ most potent policy issue—has been especially conspicuous, given that her entire campaign theme is about how she Has a Plan for That. Taking a firm, clear stance on it makes political sense as she battles for the progressive mantle.

The reaction from the rest of the candidates reflected an important reality about the issue, though: Sanders-style single payer is not an obvious winner during the general election. Polls have shown that voters like the phrase Medicare for All when they think it just means that everyone will have the option to sign up for Medicare and tend to sour on it when they’re told it would involve banning private insurance. However annoying copays and deductibles might be, people are hesitant to give up the coverage they get from their jobs. Maryland Rep. John Delaney—of all people—managed to extract an applause line out of this dynamic. “One hundred million Americans say they like their private health insurance, by the way,” he said. “I think we should be the party that keeps what’s working and fixes what’s broken. Doesn’t that make sense?” The crowd briefly went wild.

There was another subtle but revealing aspect to the health care debate onstage. Both Delaney and Beto O’Rourke made a point of mentioning how union members should be able to keep the coverage they’ve negotiated for, which they theoretically could not do under single payer. This is a major sleeper issue with health care: Some major unions are cold on Medicare for All, ostensibly because they think it will give people fewer reasons to organize and pay union dues, or perhaps because they’re not sure a government plan will actually be as good as what they currently have. “My dad was a union electrician. Right, I actually grew up in a work class family. He loved the health care that the IBEW gave him. And I think about my dad in anything I do from a policy perspective. He would look at me and say, ‘Good job, John, for getting health care for every American. But why are you taking my health care away?’ ” Delaney said. If Warren is the Democrats’ nominee, she’s going to have to answer that question.