Voters, however, appear more ambivalent. Though health care has long topped the electorate’s list of concerns, including in the 2018 midterms, surveys suggest that most Democrats want their party to focus on fixing the Affordable Care Act rather than on starting a long-shot bid for a single-payer health care system . In a recent Kaiser Family Foundation poll, some 56 percent of Americans, including nearly a quarter of Republicans, supported the idea of a new federal program; but when trade-offs like higher taxes or the loss of private insurance options were factored in, that support evaporated.

As the 2020 race heats up, here’s a primer to help citizens sort out where they stand.

What are the options?

The plans currently in play differ in their particulars: Senator Bernie Sanders’s Medicare for All Act would scrap private insurance and create a new federal system to cover everyone; a plan from the Center for American Progress, a think tank, would create an optional public program that anyone could buy into ; a nd a plan from Senator Debbie Stabenow would give all Americans the option to buy into Medicare when they turn 50. But these plans would extend coverage to more people and would increase the federal government’s role in providing and policing health insurance.

The proposals fall into two broad categories: universal and incremental . On the universal side, Medicare for all would largely eliminate the need for private insurance and for other public programs like Medicaid and the Children’s Health Insurance Program. Its coverage would also be more expansive than current Medicare: It would include eye and dental care as well as prescription drugs, and it would eliminate premiums, deductibles, copays and surprise medical bills.

A single federal payer — as such proposals envision — may well eliminate the waste, inefficiency and corruption that make the current system so expensive and inaccessible ; the experience of countries like Canada and Britain that rely heavily on one government payer suggests as much. But such a system would require dramatic changes from the status quo and would be a tough political sell. What’s more, single-payer is not the only way to achieve universal coverage.

On the incremental side, several different proposals would allow certain people to buy into existing public plans. Some would enable older Americans who are not yet eligible for Medicare to buy into that program — at age 50 or 55 or 60. One would let people who don’t have other insurance coverage buy into Medicaid (as long as their state opted into the program).