Medicare for All faces a big test in Nevada’s Democratic caucus, where front-runner Sen. Bernie Sanders and former Vice President Joe Biden are pitching competing health care plans in a last-minute effort to curry favor among voters as early voting comes to a close today.

Sanders has pledged to quickly push for a national health care system that covers everyone if elected president, while Biden wants to expand the Affordable Care Act with an option to buy government insurance that would compete with private plans. Sanders faced a rash of negative headlines after an influential culinary union criticized his Medicare for All plan but appears to be leading the field with plenty of momentum as the caucuses approach. With a large population of Latinx voters and service industry workers, the Nevada caucuses will test the viability of Sanders’s approach to Medicare for All within the Democratic base.

Polling on likely Democratic caucus-goers in Nevada is sparse, but last week a poll conducted by the Las Vegas Review-Journal found Sanders and Biden in first and second place, with 25 percent of respondents expressing support for Sanders and 18 percent backing Biden. Sen. Elizabeth Warren, who supports creating a Medicare for All system but only after a three-year transition period, came in third with 13 percent. Sanders has surged in Nevada since November, when Biden held a significant lead in the field.

Warren has backed away from campaigning on Medicare for All while Sanders has made it central to his campaign. A TV ad launched by the Sanders campaign in Nevada this week pledges to “guarantee health care for all” under a Medicare for All system.

Biden could use a good showing in Nevada after disappointing finishes in Iowa and New Hampshire cast doubt on the viability of his campaign. As early voting began over the weekend, Biden published an op-ed in the Review-Journal in which he touted his role in passing the Affordable Care Act, and attacked Sanders and his Medicare for All proposal. Medicare for All is too expensive and doesn’t have enough support in Congress, Biden argued, and consumers should have a choice between public and private health coverage.

Biden, Pete Buttigieg and other candidates emphasize consumer choice when promoting a public option. However, Medicare for All proponents point out that employers often dictate which private plans employees can join, and Americans pay the highest costs for health care in the world thanks to profit-hungry insurance and pharmaceutical companies. Public support for Medicare for All reaches as high as 70 percent but falls when pollsters emphasize the estimated cost of such a system. Biden has repeatedly said Medicare for All would cost more than the entire federal budget, a claim that fact-checkers say is entirely false.

Exit polls in Iowa and New Hampshire found that solid majorities of primary voters support a single-payer health care system despite attacks from Biden and industry-backed groups.

The same day that Biden published his op-ed in Las Vegas, a new study published in the prestigious medical journal The Lancet cast further doubt on the former vice president’s claims. Conducted by a team of epidemiologists, the study calculates that Medicare for All would save Americans $450 billion and prevent 68,000 unnecessary deaths annually.

Like previous research, the study found that a Medicare for All system would cost less than the current system due to reduced overhead, and lower-income patients would benefit the most. People would generally be healthier because financial barriers to care such as surprise bills and insurance deductibles would be removed, lowering system-wide costs in the long-term and saving lives. Hospitals would see large savings as billing systems streamline, and doctors would have more time to spend with patients. Hospitals that regularly provide uncompensated care to low-income patients would benefit substantially.

In a statement, the Sanders campaign did not address Biden’s claims directly but noted that the study “debunks” attacks on Medicare for All lodged by the private health care industry, which made “well over $100 billion in profits last year.”

“While the CEOs in the pharmaceutical and health insurance industry may not like it, we will end their greed and enact Medicare for All when I am president,” Sanders said.

Eagan Kemp, an expert on health care policy at the progressive advocacy group Public Citizen, said conservative and industry-backed groups, such as the Coalition Against Socialized Medicine and the Partnership for America’s Health Care Future, are “blanketing” Nevada and other primary states with anti-Medicare for All messaging. However, these attacks appear to be provoking a backlash in the Democratic base and emboldening a growing grassroots movement that is pushing local leaders to pass resolutions in support of Medicare for All. In Pennsylvania, for example, cities including Bethlehem, Pittsburgh and Philadelphia with a combined 3 million residents have passed resolutions in support of Medicare for All.

Kemp said exit polls in Iowa and New Hampshire found that solid majorities of primary voters support a single-payer health care system despite attacks from Biden and industry-backed groups, and health care is bringing people out to the polls. Many voters support both Medicare for All and a public option, a clear sign that Democratic voters demand a better health care system and remain angry about Republican attempts to dismantle the Affordable Care Act.

“The fact is, you’re seeing this battle-tested support in these early swing states, and there’s no reason to think that Nevada is any different,” Kemp said in an interview with Truthout.

Sanders’s approach to Medicare for All came under scrutiny last week after the influential Nevada Culinary Workers Union circulated a pamphlet warning that members would lose a health care plan that the union spent years bargaining for under the proposal. In an unusual move, the union did not endorse any of the Democratic candidates and instead outlined policy goals.

Voters tend to give Sanders credit for consistency, and Sanders refused to budge despite the negative headlines that followed the culinary union’s announcement. In a statement, Sanders said health coverage for union workers would be “preserved and expanded” under Medicare for All, and non-union workers and striking workers would be covered as well. As Truthout has reported, Medicare for All would also take health care off the bargaining table, allowing unions to focus on improving wages and other work conditions. Kemp said many unions and workers in the labor movement support Medicare for All, even if they already have decent health coverage.

For Sanders, a strong showing in Nevada would be a good sign that his messaging around Medicare for All is reaching voters.

Polls show health care remains a top issue for Democratic voters — and it’s the top issue for women over 50 years of age in Nevada, regardless of political affiliation, according to one of the few polls on health care available. Women over 50 in Nevada are most likely to blame pharmaceutical companies and private health insurers for escalating health care costs, according to the American Association of Retired Persons (AARP). Both Warren and Sanders have also placed the blame for high health costs on these industries.

For Sanders, a strong showing in Nevada would be a good sign that his messaging around Medicare for All is reaching voters, despite attacks from pro-industry groups and the kerfuffle with the culinary union. As for Biden, his criticisms of Medicare for All sound a lot like those coming from conservatives and the industry. A poor showing in Nevada would be evidence that his health care strategy continues to backfire.

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