WASHINGTON, Iowa — Beto O'Rourke, on his first trip to Iowa as a presidential candidate, broke with prominent 2020 Democrats and some of his past statements in saying that his goal for health care is not necessarily a single-payer system.



Asked directly Friday if his goal is to get to a single-payer system, he said, “No, my goal is to get to guaranteed, high-quality universal health care for all, and I think there are many ways to get there."

In response to a separate question, that he's "no longer sure" that Medicare for All or a single-payer system would be "the fastest way for us to get there."

Like with other policy issues early in his campaign, O'Rourke said he is "very open to listening to others" as he decides on what the best way to get to universal coverage would be, particularly calling out a "Medicare for America" plan in the House that would allow people who choose to keep employer-based care and open up Medicare for people without employer-based insurance.

O'Rourke has been hard to pin down on health care. Early in his Senate campaign, in June 2017, O'Rourke said on Facebook that a "single-payer Medicare-for-all program is the best way to ensure all Americans get the healthcare they need." But he did not sign onto a Medicare for All bill in the House, telling the Texas Observer later that year that he disagreed with some of the plan's specifics. During his campaign last summer, he talked primarily about “universal, guaranteed, high-quality health care for all," not specifically mentioning single-payer or Medicare for All.

The Medicare for All plan, which would radically alter the current health care system in favor of a government-run single-payer system, is a pivotal policy for several 2020 Democrats. Sen. Bernie Sanders made it a hallmark of his 2016 campaign, and is doing so again now. His Senate Medicare for All bill is cosponsored by several of the other presidential candidates — Sens. Cory Booker, Kamala Harris, Elizabeth Warren, and Kirsten Gillibrand.

O'Rourke said Friday he has issues with people not having a choice under a single-payer system.

"Over time, I hope Medicare has the investment and buy-in necessary that people choose to leave employer-based insurance instead of being forced to," he said.