Could Biden actually be out of step with voters on health care? Photo: Spencer Platt/Getty Images

The success or failure of Joe Biden’s quest to return to the White House — this time as president, not just uncle-in-chief — depends not just on his name recognition, but on the appeal of his pragmatist policies. Though it’s still much too early to know if Biden’s gambit will win him the nomination, his commanding lead appears to have lent him confidence; he’s doubling down on his relative centrism, rather than allowing the more progressive candidates in the race to push him toward the left. On health care, Biden’s intransigence is particularly apparent. Bloomberg News reported on Wednesday that in New Hampshire, Biden said that he opposes a national health-insurance program because “the vast majority of people are satisfied with their own health-care system today.”

Biden’s statement seems in line with an emerging theme of his campaign. Donald Trump is an aberration, and the former VP’s Republican friends will have an epiphany; soon enough, the country will wake up from its fever dream and go back to the way things were before Trump entered the GOP primary. And perhaps that’s what many Democratic voters want to hear. Biden’s lead suggests as much. In interviews with Bloomberg, Democratic voters seemed to sort themselves into two camps: Biden loyalists who share the candidate’s moderate views, and left-wing voters who believe in Biden’s electability, if not necessarily his policies. “I want to vote on who’s gonna be able to win the election,” one voter told the news outlet. “I’m a lefty’s lefty but you’ve gotta get this arrogant, narcissistic, lying bigot out of office.”

The primary is young, and so is Biden’s latest campaign for president. He may owe his lead to his centrism; that’s certainly the outcome he and his advisers had hoped to see. Biden’s pollster, John Anzalone, told the Washington Post in March that it was “a myth that Alexandria Ocasio-Cortez somehow represents the narrative of Democratic primary voters in the country.” But even if you believe the policy priorities of the party’s activist base are somehow out of sync with the average Democratic voter, Biden’s relatively optimistic view of the nation can sound hollow — and misleading. Biden’s statement on health care, for example, doesn’t quite line up with what we know about public opinion on health care.

Most people say they’re satisfied with the quality of the health care they receive, though there seems to be a sharp distinction between how Americans view their own care and the state of the nation’s health care overall. Seventy-seven percent of Americans told Gallup in 2017 that the quality of their personal care was good or excellent, and 61 percent said they were satisfied with the total cost of their own care. But Americans have been significantly less pleased with the U.S. health-care system for decades. In November 2018, Gallup reported that 79 percent of Americans were dissatisfied with national health-care costs. In the same poll, only 34 percent described health-care coverage in the U.S. as excellent or good, with 40 percent calling it fair, and 26 percent saying it’s poor. Consider those results along with other polls: one, from Pew, found that lowering health-care costs was a “top priority” for 69 percent of voters, and a 2017 Gallup poll found that 71 percent of Americans believed the national health-care system was “in a state of crisis” or “has major problems.” Taking the broader spectrum of Americans’ health-care views into account, Biden’s imprecise assertion —that they’re “satisfied with their own health-care system today” — seems dubious.

The Biden campaign has yet to release a detailed health-care proposal, though Biden has said that he supports a public option to buy into Medicare. That stance places him at odds with candidates like Bernie Sanders and Kamala Harris, who have both endorsed health-care reforms that would eliminate private insurance. Biden’s preferred compromise does poll well; a Kaiser Family Foundation poll found that 74 percent would back a national health plan that resembled a Medicare buy-in. Support for Medicare for All, meanwhile, is increasing, though it remains lower than support for a buy-in, and varies depending on how polling firms phrase their questions. In January, a Kaiser poll found that 56 percent of respondents supported Medicare for All; that figure increased to 71 percent when they were told that the plan would guarantee them health insurance. As the Associated Press reported at the time, only 32 percent supported the plan “if it would threaten the current Medicare program.”

Of course, fluctuations in public support don’t have any bearing on whether or not the public option is substantively superior to Medicare for All. Only the latter promises universal coverage, and as we get deeper into the campaign, that may prove to have significant appeal. The Kaiser Family Foundation poll that found high rates of support for a Medicare buy-in also found that among Americans who favor a national health plan, 89 percent prioritized universal coverage. As health-care costs rise, even for employer-provided insurance plans, Americans may become less and less likely to prize private insurance — especially if they learn more about other options. When it comes to the nomination, Medicare for All could still turn out to be a winning play.

Biden’s famous hot-mic moment, when he called the signing of the Affordable Care Act “a big fucking deal,” helped build his reputation as a plainspoken man of the people. But in 2019, that same quality has already begun to reveal his blind spots to the public. It’s not clear that he or his advisers appreciate either the ACA’s limitations or the extent of the crisis troubling the American health-care system. Biden, in fact, has barely said anything about health care at all, despite its importance to voters. He may ultimately be surprised by the radical solutions that voters are willing to entertain.