The first night of the second round of presidential debates showed the divisions between progressive and moderate Democrats

This article is more than 1 year old

This article is more than 1 year old

Healthcare is a defining and dividing issue for the field of Democratic 2020 presidential candidates. The first night of the second round of Democratic presidential debates, on CNN on Tuesday, was a stark exhibition of those divisions.

While all agree healthcare is a top issue, Democrats disagree about how much the government should intervene to fix America’s healthcare problems.

Why is this such an important issue?

America has the highest healthcare costs in the world and 28 million people are locked out of the system, without insurance. A simple trip to a doctor or hospital emergency room can be financially ruinous for the uninsured. Even for people who have insurance, they can quickly rack up thousands of dollars in medical debt with a sudden illness.

Electorally, it is a potent issue for Democrats. The party flipped 40 congressional seats in the midterm elections running against Republican efforts to take health insurance away by repealing the Affordable Care Act, alias “Obamacare”.

What exactly are Democrats arguing about?

There are two main stances among Democrats. The first is moderate: arguing the US should enact a “public option”, where Americans could choose to buy into a government-run healthcare system.

Barack Obama won on the promise of a public option in 2008, but was forced to abandon the proposal to pass his landmark healthcare reform legislation.

The second is a more radical solution: abandon private insurance in favor of government-run, single-payer healthcare – a plan often known as Medicare for All. This would more closely resemble the National Health Service of the United Kingdom, although under the British system people can also buy private health insurance if they wish.

Why is providing health insurance through the government so controversial?

It’s all about which proposal can unseat Donald Trump.

Warren and Sanders face fierce challenges by moderates during tense debate Read more

Moderate Democrats believe independent voters will reject a proposal like Medicare for All. Republicans, they fear, can easily paint the proposal as socialist government intervention to a nation that values individualism. Progressives believe big ideas will win the day, and radical reform is the only way to fix the broken economics of healthcare.

Would half the US really lose their healthcare if the government took over?

It’s complicated. About half of Americans rely on health insurance provided through employers. They have no choice about which insurance they are provided.

Under a Medicare for All proposal, they would no longer need private health insurance, but would pay higher taxes, such as in the UK. Already, a family of four earning $50,000 a year pays $7,450 on average in health expenses and health-related taxes each year.

Moderates argue many Americans are satisfied with their private health insurance, and Democrats should not work to upend that system if people like it. When Obama proposed the ACA, he said people would be able to keep their insurance, but many experienced changes when his reforms were enacted. This became a potent Republican talking point, and helped many candidates (including Trump) march to victory.

Either of these options shows just how much there is at stake for Americans, as Democrats take on Trump, and a broken health system.