Its realization may cost him his job. “I think it’s the deciding factor for me,” said McCoy, 43. “It’s my livelihood.”

It’s a question that likely hangs over him more than most. As an employee in a private health insurer’s grievances and appeals department, the Sanford, Maine, resident said he’s undecided on Medicare-for-all — the very proposal his top two choices for president, Sanders or Senator Elizabeth Warren, are championing.

DOVER, N.H. — Like others who packed into an Elks Lodge here Saturday to hear Senator Bernie Sanders’s vision for government-run health care, James McCoy has watched people get buried in bills their insurance won’t cover, only to wonder if there is a better way.


McCoy’s dilemma offers an example of the anxiety that surrounds one of Sanders’s defining proposals, which would transform how health care is delivered in the United States and is deeply popular with his supporters — but also has divided the Democratic presidential field and voters in general.

Sanders has long embraced the concept, and the Vermont senator and his surrogates often remind voters that he “wrote the damn bill,” as they did Saturday.

“I think Bernie has the only [plan] that makes sense,” said Jane Laberee, a 63-year-old Dover resident. “It gives the broadest coverage. I think it is very practical.”

Sanders asked people in the crowd to share their experiences, with stories ranging from juggling a $12,000 deductible to being in fear of seeking a better-paying job with the risk of losing Medicaid benefits.

“Am I missing something or is this totally insane?” Sanders asked. “This is what the [current] system is about.”

When McCoy stood and asked Sanders how Medicare-for-all would affect his job, Sanders was blunt.

“Will there be job loss? Yes, there will be,” he said, but added that his plan would also include job training to help those in the industry find new employment.


McCoy said afterward that he appreciated Sanders’s honesty, but added, “I’m not sure how I feel about his answer.”

Public support for Medicare-for-all has dipped in recent months, though it remains popular with Democrats. A late-November Quinnipiac University poll found that 52 percent of all American voters think it’s a bad idea, compared to 36 percent who say it’s a good one. That’s a change from March, when the split was closer, 45 to 43 percent, respectively.

Among voters who are Democrats or lean Democratic, 59 percent say it’s a good idea to replace the current system with a single-payer one, according to the same November poll.

Warren has tied herself to Medicare-for-all, promising that in her first 100 days in office if elected to dramatically expand government health insurance. The Massachusetts senator also released an outline of how to fund a $20.5 trillion Medicare-for-all plan, along with a two-step process that would include legislation to transition to a fully government-run system by the end of her third year in the White House.

Sanders has promoted what he’s called a more “progressive” approach that relies on a single bill to transition to Medicare-for-all. It would include raising taxes on employees — a 4 percent tax on income above $29,000 — as well as employers, he said, but unlike Warren, Sanders has not specified a detailed financing plan for it.

The 78-year-old former mayor has pointed to the high costs many already pay for health care in justifying the transition.


“Everybody asks me, all my opponents and the media and the drug companies, ‘How are you going to pay for it?’ ” Sanders said. “Let’s ask for a moment a question that we don’t ask: How are we paying for it today?”

Sanders, perhaps insulated to a degree by his longstanding support of the idea, also hasn’t faced the same degree of blowback on the plans that has battered Warren as her poll numbers and fund-raising have dipped in recent months.

Among his supporters who flocked to Dover on a mild winter afternoon Saturday, there was wide support for Medicare-for-all, even with the recognition it could face hurdles.

“I believe it would have to be a slow process moving toward that,” said Liz Hunt, a 58-year-old nurse practitioner from Berwick, Maine, which straddles the New Hampshire border. She supports a form of Medicare-for-all, she said, but “I don’t believe it’s realistic to step in and wipe out all private insurance.”

David McDermott, of Portsmouth, N.H., said he supports a more progressive approach toward health care, and acknowledged the campaign trail proposals, should one pass, likely won’t survive the legislative process completely intact.

“It’s not going to be one person’s proposal out of the box,” said McDermott, 64, who’s also backing Sanders. “But I think it’s a good mission to be done.”

Matt Stout can be reached at matt.stout@globe.com. Follow him on Twitter @mattpstout