Why Sanders and Biden Are Sparring Over Health Care

To Biden, the Democratic front-runner, Medicare for All is a costly and complex proposal that means eliminating private health insurance — and scrapping the Affordable Care Act.

“I knew the Republicans would do everything in their power to repeal Obamacare,” he said in a video this week as he rolled out his own health care proposal. “They still are. But I’m surprised that so many Democrats are running on getting rid of it.”

After months of warily watching each other from afar, Sanders and Biden, two Democratic septuagenarian contenders for president, have taken aim at each other on the fraught and critical battleground of U.S. health care policy.

Sanders in particular has escalated the attacks in recent days. His campaign called Biden’s health care plan “Bidencare” and even released a video that accuses him of “lying” about Medicare for All. But Biden, too, has been a more-than-willing participant, openly criticizing Medicare for All on multiple campaign swings over the past week.

Their sparring reflects strategic political calculations. For Biden, who appears increasingly willing to draw contrasts with his Democratic rivals after a rocky first presidential debate, health care provides a way to highlight distinctions between himself and several opponents who support Medicare for All, including Sanders and Sens. Kamala Harris and Elizabeth Warren.

For Sanders, outraised by several rivals including Warren and falling in some polls, Medicare for All — which he has preached for decades — offers a possible path back to the center of the national political conversation.

But there is more to their jousting than just normal campaign maneuvering. Health care is a personal issue for both men — to Sanders, it is a fundamental human right and embodies his lifelong message of economic equality. To Biden, who was vice president to Barack Obama when the Affordable Care Act was passed, it is also connected to the death of his son Beau Biden, who died after a battle with brain cancer.

Politically, polls show that health care is a top priority for Democrats, and an emphasis on protecting people with preexisting conditions and reducing health care costs helped Democrats in last year’s midterms when they picked up 40 seats in the House. With Trump and Republicans repeatedly threatening to unravel Obamacare, Democrats hope that the issue of health care will again work in their favor.

If Sanders and Biden have both seemed at times to relish the debate, it has also thrown into sharp relief two competing visions for the Democratic Party.

Biden embraces fixes to the health care system and the addition of a public option, rather than a full-scale overhaul, portraying that approach as more pragmatic in today’s fractured political landscape, to say nothing of appealing to a nostalgia for the Obama era. The other view, championed by Sanders and others on the left, is that the nation’s challenges are so significant that only the boldest, most transformational proposals will do.

The philosophical clash erupted Wednesday when Sanders delivered a formal address in Washington on the merits of replacing the health care system with Medicare for All, saying his plan would “save lives” and urging presidential candidates to reject contributions from the health care industry.

Though he did not mention Biden by name, he took several veiled swipes at him, joking about how much Americans love their private insurance (they do not, Sanders claimed, though polls tell a more complicated story) and about how they love paying their insurance premiums (ditto).

It was a conflict that had been simmering for days.

Last week, Biden told reporters in Portsmouth, New Hampshire, that Medicare for All is not “Medicare as you know it.”

“It is one that I think is going to be difficult to pass, No. 1,” he said. “But No. 2, I think people should be able to be in a situation, if they want to keep their employer-based insurance, they should be able to do it.”

Though Biden said Sanders had been “very honest” about the costs of Medicare for All, he still drew a forceful rebuke from the Vermont senator, who accused Biden of echoing the insurance and pharmaceutical industries — and Republicans — in his criticisms of Medicare for All.

And Monday, Sanders blasted Biden’s health care plan, suggesting it was aligned with “corporate greed.”

Sanders is running in the Democratic primary but is an Independent from Vermont.

Aides to Sanders suggest the escalating confrontation plays into his hands: They have been trying to frame the primary as a competition between him and Biden, hoping to set up the same kind of insurgent-versus-establishment contrast that worked to Sanders’ advantage in 2016, when he was the foil to Hillary Clinton. And they view poaching supporters from Biden, particularly working-class Democrats, as the most promising way for Sanders to grow his base.

To help their case, they have been urging Sanders to go after Biden more aggressively.

Yet for weeks, they have remained frustrated with polls showing Biden still leading Sanders by comfortable margins, some allies said. The recent surges by Warren and Harris and the fundraising prowess of Mayor Pete Buttigieg have also dispelled the notion that it is a two-person contest.

“He’s clearly losing support, both in the national polls and in states,” Stan Greenberg, a veteran Democratic pollster, said of Sanders. “He has no choice. I think he’s made a decision, he’s got to make himself relevant again. Health care was the issue in which he was relevant last time, and it was very important in the campaign in 2016, so I think it makes a lot of sense for him to try to draw this contrast on health care, particularly in the primary.”

Mark Longabaugh, who was one of Sanders’ top advisers in 2016 but left the 2020 team this year, said Sanders was “really good in a contrast.”

But he cautioned that the senator would be ill-advised to discount his other opponents at this point.

“You’ve got obviously several other significant candidates and actors in this thing,” he said. “I just don’t see this election turning into a Biden-versus-Bernie race.”

Biden’s allies point to the political realities in Washington — which includes a Republican-controlled Senate — as evidence that passing a sweeping overhaul of the nation’s health care system would be exceedingly difficult and argue that Biden’s proposal is more realistic.

“I’m not so sure anyone believes Americans are ready to go through a wholesale change in the health care system,” said John Anzalone, a Biden pollster. “Joe Biden is approaching this as, people are hurting, what can we do now, or in the very near future, when a Democrat is president?”

In a separate interview over the weekend with The New York Times, Sanders appeared to acknowledge the steep political requirements of his proposal, saying “a Democratic Senate is certainly absolutely imperative if we’re going to go forward” and added that members on both sides of the aisle would have to come together to create “a system which is designed not to provide huge profits for the drug companies and the insurance companies but quality care to all people.”

As the battle over health care continues, even Sanders’ advisers are no longer hiding their distaste for Biden’s criticisms.

“This campaign will not be a punching bag for misinformation out of the Biden campaign,” said Jeff Weaver, Sanders’ 2016 campaign manager and his closest adviser.

Referring to the last presidential contest, he added, “If people want to go into the general election in 2020 with a candidate with the same set of policy prescriptions as 2016, that’s a real roll of the dice.”

This article originally appeared in The New York Times.