The 2 big disagreements between the 2020 Democratic candidates on Medicare-for-all

Democrats diverge on not only policy, but politics too, when it comes to health care.

Dylan ScottJun 25, 2019, 9:34am EDT

The Democrats running for president in 2020, while sharing a general goal of “expanding health coverage,” have two fundamental disagreements about health care. 

One is on the policy: Would the best insurance system be one fully funded by the federal government? The Democrats who support Sen. Bernie Sanders’s Medicare-for-all bill are saying it is, while other candidates prefer to build more gradually on the public-private system we have now or openly running against the idea of single-payer. 

The other debate is over strategy: Even if Democrats are lucky enough to win full control of the government in 2020, which is by no means guaranteed, should they try to enact another major health care overhaul? Or should they use their time, energy, attention, and political capital for other pursuits?

The delineations on policy are obvious as candidates come forward with their plans. The divisions on strategy are a little more speculative: Sanders’s supporters on the left have recently been suggesting Elizabeth Warren’s more circumspect approach on the timeline for Medicare-for-all, which she supports, means she isn’t as progressive as their favored candidate.

As the first debate approaches, the candidates are being delicate on health care, trying to signal their support for aspirational and broad goals like universal coverage. Most of them would rather not get bogged down in the devilish details — but as long as Sanders, an unreserved supporter for single-payer, is a major figure in the race, that will be difficult to do.

The actual policy disagreements Democrats have about health care reform

This month, House Democrats held a health care hearing about “paths to universal health coverage.” This is the story Democratic leadership wants to tell: The party agrees America should cover more people with public programs or subsidized private health insurance (or both). They are just looking for the best path forward.

“We all agree we need a stronger health care plan that covers everyone, universal coverage. We want everyone to have it,” Senate Democratic leader Chuck Schumer told Vox earlier this year. “We’ll figure out the best way to get there. … Different people have different views, we don’t attack each other. I think it’s great.”

But there are meaningful differences between the current left-of-center proposals. This Venn diagram covers the bills in Congress, written into real legislative text, and ideas from two prominent DC think tanks. On critical questions about whether the 150 million people who have employer-sponsored insurance should have access to a government plan, who else would be covered, and how much they would be asked to pay out of pocket for health care, the plans have notable differences. They do also have shared features.

Sanders wrote the single-payer bill in the Senate, which would move every American into one national insurance plan and would cover most medical services at zero cost when people go to the doctor or hospital. Warren and Sens. Kamala Harris (D-CA), Cory Booker (D-NJ), and Kirsten Gillibrand (D-NY) signed onto his Medicare for All Act. The Sanders plan is the most maximalist overhaul in the field, a nationalizing of the health insurance industry.

The Medicare for America bill, based largely on the work of the Center for American Progress (CAP) and Yale professor Jacob Hacker, would maintain the employer-based system that covers half of Americans right now. It would also, however, allow almost any American move to a government plan if they wanted to. Beto O’Rourke and Pete Buttigieg have shown support for that idea. They like to say they support Medicare “for all who want it,” a halfway point between single-payer and more limited public options.

Joe Biden has said he supports allowing “every single American” having access to a public insurance plan, but his campaign has not yet released the details on his proposal. In his record already: He called the Affordable Care Act “a big fucking deal” right after President Barack Obama signed it.

The more limited public options and buy-ins, like legislation sponsored by Sens. Amy Klobuchar (D-MN) and Michael Bennet (D-CO), would generally allow the 10 million people who buy private insurance on the Obamacare marketplaces to join a public plan instead if they pay a premium. People on company-funded plans would not be able to buy the public plan, limiting the size and impact of the program.

The health care debate is also a question of priorities and politics

But even Medicare-for-all-supporting candidates have sought out some wiggle room on the more difficult challenges presented by the single-payer plan. The Sanders bill would largely ban private health insurance. Yet Harris and Booker — both sponsors of it — have indicated at times on the campaign trail that they do see a role for private coverage.

The second question on this great New York Times survey of most of the 2020 candidates revealed some telling differences: Would your focus be improving the Affordable Care Act or replacing it with single-payer? Sanders took an absolutist tone.

“Clearly we need to replace it with a popular system, and that is Medicare, and expand Medicare to all,” Sanders said.

But another Medicare-for-all sponsor, Booker, pledged to pursue a public option first as president. 

“I’m going to fight to try to expand access through things like creating a more vibrant, robust public option,” Booker said.

Warren gave a more guarded answer, not dissimilar from Harris’s general line on health care: Medicare-for-all should be the goal, but it’s something the country may have to build toward. 

“There are a lot of different ways to get there,” Warren told the New York Times. “‘Medicare for all’ has a lot of different paths.”

Warren has an Obamacare improvement bill that, while not campaign stump speech material, would expand the federal subsidies available through Obamacare and extend them to more people. That plan would be one possible next step for her administration.

The activist and ideological left, for whom Sanders is such an important figure, have seized on Warren’s equivocation, contrasting it with her cultivated image as the bold “plan” candidate on other issues. From Tim Higginbotham’s essay in the socialist journal Jacobin, bearing the title “Elizabeth Warren Has a Plan for Everything — Except Health Care”:

Taking this answer at face value, it seems Warren sees herself pursuing an incremental approach that expands public coverage while preserving the private insurance industry should she be elected president. This would likely surprise many of her supporters, who might view her cosponsorship of Sanders’s Medicare for All bill as an endorsement of single-payer health care.

It’s fair to ask why Warren, who supports bold, progressive policies on a number of major issues, is avoiding the most important issue to voters. It could be a reluctance to attach herself to a rival candidate’s signature policy, or it could be a way to avoid conflict with the powerful health care corporations in her home state of Massachusetts.

As Vox’s Tara Golshan explained, Sanders and Warren are sometimes seen as so similar on policy that some people apparently have trouble telling them apart. Sanders’s side clearly sees health care as an opening to contrast them because their candidate says he is invested in passing Medicare-for-all as soon as possible. 

Candidates have other plans they want to prioritize. Warren told Vox’s Ezra Kleinthe best place for her agenda to start is with an anti-corruption reform package. She’s been one of 2020’s trendsetting candidates on taxing the rich and expanding workers rights.

Harris, the next highest-polling Medicare-for-all sponsor, says she aspires to Medicare-for-all but has left room for leaving some kind of private insurance or incremental reforms. Her campaign also told me earlier this year that Harris’s tax plan would be at the top of her to-do list.

How much will these differences matter in 2020 and beyond?

Among Democrats, a tug-of-war exists between governing and ideology. Some Democrats think single-payer is the only acceptable answer if health care is a human right. Others are chastened by the recent and fierce fights over more limited reforms and want to instead focus on what is politically possible. The left’s theory is that incrementalists are too timid about what is achievable with the right message and the right plan. 

“Medicare for all” polls well and health care is a unique issue: Americans broadly accept a role for the government in making sure people have health insurance. There are a lot of Medicare-for-all supporters in the Democratic Party now and among the people who vote in primaries. A recent survey of likely Iowa caucus-goers found about half said a candidate’s support for single-payer would be a “must-have” for them in 2020. That’s quite a few voters in such a crowded field. 

Other polling indicates a lot of voters are still fuzzy on the details of Medicare-for-all, like whether it would get rid of private coverage. Support for the proposal still seems fluid, with push polls finding attacks on single-payer do significantly drive down support. The “must-have” number from the Iowa survey — 48 percent — reveals a lot of Democratic voters who aren’t making single-payer a deciding factor. Joe Biden, doing well with and focusing on the party’s older and moderate voters, is building his candidacy with voters like that.

Polling from public-opinion researcher Michael Perry, not done for any outside group, found Democratic voters saying that they would focus on improving Obamacare over passing single-payer in the near term. The Sanders wing is now questioning Warren’s commitment to Medicare-for-all, but so far, the 2020 polls show Warren and Sanders splitting voters who identify as progressive or liberal.

Still, health care reform has been politically challenging and historically an electoral loser, as Democrats and Republicans saw in 2010 and 2018, respectively. And whether Medicare-for-all can actually pass — or whether a more incremental option is the only thing that could clear a narrowly Democratic Senate with a solid cohort of centrist members — is a very different question. Sens. Joe Manchin of West Virginia and Kyrsten Sinema of Arizona, for starters, don’t sound onboard with single-payer right now. They just got elected for a barely-started six-year term.

A Sanders administration would also need a Democratic Senate to change the Senate’s procedural rules, which currently set a 60-vote threshold for most bills, to pass the best version of Medicare-for-all — and on that subject, eliminating the Senate filibuster, Sanders is actually more wary than Warren.

But there’s also a large chance this could all be moot. Democrats will need to be a little lucky to win the Senate at all. If they don’t, Senate Republican leader Mitch McConnell relishes the chance to block progressive — he’d call it “socialist” — legislation, as we’ve seen with a Democratic House. President Donald Trump has already called out “socialist” single-payer in his 2020 reelection launch speech.

It might seem strange for Democrats like Sanders and Warren who sponsor the same plan to be “debating” an issue. In this crowded field with a lot of policy overlap, campaigns are looking for every opening to stick out to voters.

But the party broadly does still has real differences not only on the best political path, but the right policy. Center-left Democrats really want to preserve a big role for private insurance. The candidates are asking elemental questions among themselves about the free market and the role it should have in providing health care to Americans.

I haven’t posted much lately due to a few health problems which I think are mostly cleared up now. This article from The New York Times interests me because I have been an opponent of the death penalty for many years. I believe my opposition grows out of the influence of Jesus Christ in my life. My relationship with Him has been a corrective to many of the “natural” inclinations of my human heart. For example, having grown up in a segregated and prejudiced society, it was “natural” for me to be a racist. However, while I believe that I have racist tendencies deeply ingrained in my being, I strive not to be racist.

In the same way I am “naturally” inclined to be vengeful. When I hear of the hateful things that people do to one another, I want to take revenge. However, I believe that Jesus has directed us to a better way, the way of forgiveness. This “unnatural” idea rings true to me because I believe that vengeance is harmful to the one–or to the society–that seeks revenge. For me, the death penalty encourages us in the wrong direction.

Whatever your point of view, I think you will enjoy reading about Sister Helen.

Sister Helen Prejean Explains It All for You

By Penelope GreenMay 31, 2019

NEW ORLEANS — Thirty-five years ago, when Sister Helen Prejean was in the death house at the Louisiana State Penitentiary in Angola waiting to witness the execution by electrocution of Elmo Patrick Sonnier, the guard in charge asked her, “What’s a nun doing in a place like this?”

“Dead Man Walking,” her harrowing 1993 book about her experiences on death row, was one answer. In it, she writes of how she became a pen pal and spiritual adviser to Mr. Sonnier, who had been convicted, with his brother, of killing a teenage couple parked on a lover’s lane after raping the girl. 

Sister Helen described her horror at the barbaric crime and at its barbaric consequences, her stumbles with the victims’ families and her education into the injustices of the death penalty and death penalty convictions. Her conversion to activism would in time make her one of the country’s best-known death penalty abolitionists, and maybe its most famous nun. 

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The book was a New York Times best seller, and then a movie, an opera (with a libretto by Terrence McNally) and an educational program. The film, out in 1995 and made by Tim Robbins, starred Susan Sarandon as Sister Helen and Sean Penn as the death row inmate. Ms. Sarandon won an Oscar, wearing a coppery Dolce & Gabbana gown to the ceremony. 

Sister Helen, who had shed the habit in the late 1960s (as many nuns did post-Vatican II; the ecumenical council began in the early ’60s to modernize church practices), wore a black top and a long flowered skirt she borrowed from a friend. What would the nun wear? was big news at the time, Sister Helen recalled. 

On a recent July day she was in a white polo shirt printed with sprigs of flowers, khaki-green denim pants and wedge sandals, greeting a reporter to discuss her new book, “River of Fire: My Spiritual Journey,” out on Aug. 13, a memoir of her life up until the moment she began to correspond with Mr. Sonnier. 

In it, Sister Helen, who was raised in Baton Rouge and is of French Cajun descent, tells how a precocious Catholic girl turned nun shed her cocoon of privilege long after the social revolutions of the 1960s and the attendant reformations and renovations of Vatican II transformed many sisters into social justice activists.

“Don’t hold your breath,” she writes. “It’s going to take a while.”

But being a nun has always been a radical act. What’s more counterculture, Sister Helen said, than joining a convent?

‘Catholic Prozac’

Sister Helen, bane of prosecutors, was settled into a recliner topped with a lace antimacassar stitched with her last name, having moved papers, letters and her journal out of the way. With short, bushy brown hair, big round glasses and a luxurious Louisiana way with vowels, she looked about 65, though she turned 80 in April. 

She lives in a modest two-bedroom apartment, a few blocks from the fairgrounds in New Orleans, running her organization, the Ministry Against the Death Penalty, from the apartment next door. 

The staff of five includes Sister Margaret Maggio, an old friend who is also in Sister Helen’s order, the Sisters of St. Joseph, and Rose Vines, an Australian writer, activist and atheist. There are debates on cosmology and quantum physics over scotch (Sister Helen) and gin and tonics (Ms. Vines).

A framed print of Fra Angelica’s “Annunciation” hangs over Sister Prejean’s computer monitor, taped to which is a photo of Dzhokhar Anzorovich Tsarnaev, the convicted bomber of the Boston Marathon, printed with the words “Pray for Dzhokhar.” 

In 2015, after meeting with him five times at his lawyers’ request, Sister Helen testified on his behalf. The prosecution had fought hard to keep her off the stand, and attacked her testimony as being biased. “I presented him as human being,” she said. Nonetheless, the jury returned a death sentence. 

In the bathroom, there was a quiz deck of landmark American Civil Liberties Union cases.

“Here’s the spark at the heart of all this,” she said. “The big annunciation” — she nodded at her Fra Angelica print — “was writing a man on death row and witnessing his execution. When I walked out of that execution chamber, all this was new to me. I didn’t know anything about the criminal justice system. I love to quote what Tim Robbins said: ‘The nun was in over her head.’ Back then I didn’t know anything.”

Sister Helen grew up in an affectionate Catholic family. Her father was a lawyer; her mother, a nurse. They loved language, drawing on both Roget’s Thesaurus and Groucho Marx — and the Virgin Mary. On family trips, the family of five said three rosaries a day, as Sister Helen writes, “surefire Catholic Prozac for three squabbling kids in the back seat.” 

In eighth grade, she declared she would grow up either to be pope or president. She was curious about romantic love, but had ambitions outside of marriage and children. She was 18 when she joined the Sisters of St. Joseph’s, an order begun in France in 1650 with a particular mission for the education of girls.

She was a scrappy, mouthy novitiate, often in trouble. Bounding out of the family station wagon on the day she joined the convent, she announced, “I’m here! I’m here to become a bride of Christ!’”

And she was wildly competitive, once practicing the down-turned gaze meant to indicate modesty so zealously that she knocked down another nun. 

Convent life wasn’t all rosaries and penances. When she and 13 other nuns in her community vacationed on an island off the Gulf Coast, they surfed in inner tubes and scarfed boiled crabs and cold beer. They listened to “West Side Story” and dissolved in tears.

On the first day of that vacation, an ethical dilemma presented itself: Before a trip to the beach, should they take off their habits in their camp, or cross the public highway in full nun regalia, and divest in the sand? It took half an hour of discussion before someone pointed out that the image of 14 nuns undressing on a beach and leaving their habits in a big black heap would perhaps be too unsettling.

Sister Helen read J.D. Salinger and Thomas Merton but was oblivious to the civil rights movement swelling around her, though she did learn to play “Blowin’ in the Wind” on her guitar.

At a religious education program in Ontario, she met a young priest she calls William in the book, and they fell in love. Nuns and priests were experimenting with a relationship model called “the third way,” which was sort of like dating except the couples stayed celibate and true to their orders. 

“If this sounds confusing and tricky in the extreme,” she writes, “that’s because that’s exactly what it is.” William was not only smitten with Sister Helen, he was also jealous and controlling, as well as being an alcoholic. It took seven years for her to end the relationship.

Then came a nascent feminist awakening, as she examined the meaning of celibacy beyond biology. Attending to William’s emotional needs, she writes, had consumed more and more of her time and focus, competing with “the single-heartedness” that is the essence of her vocation. 

“Virginity is completely identified with sex,” she said, “what a person has not experienced. It’s that closed-off, puritanical kind of thing.” But Sister Helen’s practice of celibacy taught her that the Virgin archetype was something more radical. “It is the single-heartedness that is the integrity in one’s being,” she said, and then quoted Jean Shinoda Bolen, the Jungian author: “She does what she does, because what she does is true.” 

It is a state available to everyone, she writes, even politicians. “Although in the United States, the brokering of money and power in politics sets the ‘purity bar’ pretty high.” 

Sister Helen’s awareness of social justice came even later, when she attended a talk by an activist nun who noted that Jesus’ message about the poor is that they be poor no longer. That their fate was not God’s will, and that just praying for people was not enough. Social justice, the nun said, meant being involved in political processes, because doing nothing was tacit support for the status quo. 

What stung the most, Sister Helen said, “was the realization of how passive I had been.” A year later, she moved into Hope House, a Catholic service ministry in a New Orleans housing project. She was 42 years old. And a year after that, she would begin writing to a death row inmate.

“I had to break out of two cocoons,” she said. “One was the spiritual one that by praying you helped the world be a better place. And the other was white privilege because I was taken care of in every way. Nuns were held in great regard. We could ride the buses free. If we went to a restaurant, someone would pay the bill. I didn’t know any poor people. I didn’t know that right down the street from the convent where I was living, in the New Orleans suburbs by the lake, were 10 major housing projects. You grow up in these envelopes. My good mama and daddy would say, ‘Now honey, it’s better for the races not to mix.’ I didn’t know booscat!”

Her family was always supportive, though often her work and her eventual celebrity made for complications. There was the time her brother, Louis Prejean Jr., befriended Antonin Scalia, the late conservative Supreme Court Justice, at a wedding, and began to take him duck hunting. When the movie “Dead Man Walking” was about to come out, Mr. Prejean proudly told the justice that his sister was going to be played by Ms. Sarandon.

As Sister Helen remembered, “Scalia says to him, ‘Just what we need. Another liberal book being made into a liberal movie.’ And Louie says, ‘Sis, I don’t think he’s too excited about your movie so I’m not going to bring it up anymore.’”

Justice Scalia was an ardent supporter of the death penalty, a position that still confounds Sister Helen. “Human beings’ ability to compartmentalize is truly an amazing thing,” she said. “The way Scalia said, ‘As a justice, I must leave my Catholic faith at the door and follow the Constitution,’ as if the moral imperative to be compassionate and forgive doesn’t give you a perspective when you look at equal justice under the law.”

“Thomas Merton,” she added, “said the end of the world will be legal.”

‘God’s Will’

Sister Helen has witnessed six executions since she watched Mr. Sonnier die in 1984. The second to last death was Dobie Gillis Williams, an African-American man with an IQ of 65, charged in the horrific murder of a Louisiana woman. “With an all-white jury,” she said, “he didn’t have a chance.” 

That was in 1999. Since then, she has been visiting Manuel Ortiz, who is also on death row in Angola, convicted of the murder-for-hire of his ex-wife for her insurance. Sister Helen and others believe that he is innocent. The drive from New Orleans to Angola is two and a half hours, and Sister Helen has done it so often, she said, “my body knows the way.”

Ms. Sarandon has also made the trip more than once, most recently to visit Mr. Ortiz with Sister Helen in late February. Theirs has been a long friendship and collaboration; at one point, the nun had her own bedroom in Ms. Sarandon’s New York apartment. 

“She’s been a great mentor and a great friend,” Ms. Sarandon said. “Somebody who always makes me laugh. One of the mistakes people make is thinking that everyone who does this kind of work is really a bore. A Debbie Downer. But Helen is really fun. She is always on a mission to learn. She keeps her heart and her mind open.” 

It took seven years to write “River of Fire.” Gloria Loomis, Sister Helen’s longtime literary agent, had been pressing the nun to tell her story for some time, but she was always on the road. 

She travels three-quarters of the year, and has spoken in all 50 states. She makes a silent retreat every year at the Trappist Monastery in Kentucky, Thomas Merton’s community, and she has been awarded 65 or so (no one is quite sure) honorary degrees, the most recent being a doctorate in divinity from Yale this spring. Her colleague Sister Margaret described her as a hurricane. 

It’s a far different life than one lived in a cloister, though Sister Helen said that she considered that path for one weekend in high school. (Ms. Sarandon said, “You can imagine how crazy Helen would have been in a cloister.”)

“There’s this thing of how you discern God’s will in your life,” Sister Helen said. “Or how your boat catches a wave and you begin to ride the current. There’s different ways of talking about it.” These Millennials Got New Roommates. They’re Nuns.A project called Nuns and Nones moved religion-free millennials into a convent.

Randy Hoover-DempseyLearning More Every Day

My daughter and I were flying back home from North Carolina. Things had started out well. It was a clear day and we saw much of the beauty of my home state as we travelled. As the Great Smokey Mountains passed below us, we began to be jostled about by a cold front that was marching from Tennessee toward the Atlantic beaches. Jostling turned to pummeling as we held onto our seat harnesses to keep from banging our heads on the windows of the plane. Many of us have experienced a difficult flight or two, but this flight was becoming increasingly problematic, the primary problem being that I was the pilot.

The wind and the shaking continued throughout the trip, and, after five hours in the air, I was relieved to be lined up for a direct approach to runway 2 at Nashville’s John C. Tune airport. Just as we were about to touch down on the welcoming asphalt a gust of wind picked up the plane and slammed us into the ground. We rebounded from the runway, hit the pavement again and then bounced higher into the air. Often in a situation like this a plane eventually lands nose first. This is not good for passengers or for the aircraft.

I heard myself pray aloud, “Jesus, help us!”, pushed the throttle to full power, and we muddled around the landing pattern one more time and landed uneventfully.

“Jesus, help us.” I’m not saying that my prayer was the cause of our successful landing, but I’m not saying it wasn’t. Actually, I prayed before the trip began for a safe journey. In fact, I pray a lot; especially when I’m troubled. However, I also go through periods of time when I forget to pray. Our plane trip can be seen as a metaphor for life. Sometimes prayer is reserved for periods of difficulty and stress. What part should prayer take in the life of a disciple? How should we pray? How can our church family be encouraged to pray?

One thing that is clear is that Jesus intends for His disciples to pray. The most obvious indication of this truth is His teaching about The Lord’s Prayer. A second indication is the example Jesus set. The New Testament records 25 times Jesus prayed. We can probably all agree that prayer is indeed an important part of the Christian life.

Father Wesley and I have been talking—and praying–about these things over the past few weeks. We want to offer our church family an opportunity to experiment with ways of praying that may be new to some of us. Beginning on Wednesday, August 7, we will offer a 6:00 PM service which will consist of The Holy Eucharist and a time of community prayer. (In other words you will not need to listen to a mid-week sermon.) During the time of prayer, we will be learning to use new prayer practices. At our first meeting we will use Anglican prayer beads to facilitate our practice. This service will last about 45 minutes.

When we pray we are participating in a mystery. One way to think of prayer is that it is the means by which the resources of heaven are applied to the things of earth. I don’t know about you, but I want all the help that God can offer!