MEDICARE FOR ALL IS ALL DEMOCRATS WANT TO TALK ABOUT.

• Author: Suderman, Peter

IN SUMMER 2009, while Democrats in Congress were deep into the process of designing the health care reform that would become the Affordable Care Act (ACA), Tea Party protests sprung up around the country in opposition to the law. In a primetime speech delivered that September, President Barack Obama hoped to convince critics on the right and in his own party that Obamacare was a middle ground between two extremes.

"There are those on the left," he said, "who believe that the only way to fix the system is through a single-payer system like Canada's, where we would severely restrict the private insurance market and have the government provide coverage for everyone. On the right, there are those who argue that we should end the employer-based system and leave individuals to buy health insurance on their own."

The following year, Obamacare became the law of the land and the signature initiative of Obama's two-term presidency. But in this year's Democratic primary contest, it has few defenders. Health care policy has dominated the early debates, consuming more discussion time than virtually any other issue. But many top-tier candidates have made the case for Medicare for All, a single-payer plan that captures elements of the extremes Obama said he wanted to avoid.

Medicare for All, as proposed by Sen. Bernie Sanders (I-Vt.) and supported by Sens. Elizabeth Warren (D--Mass.) and Cory Booker (D--N. J.), would end the nation's employer-based health care system. In the space of four years, it would implement a fully government-run system that is similar to Canada's but even more restrictive, leaving virtually no room for private insurance. Sanders' plan, according to both independent estimates and Sanders himself, would raise government spending on health care by $30-$40 trillion over a decade. It would also require tax hikes or tax-like fees on the middle class. In terms of both cost and transition complexity, it would dwarf Obamacare.

The plan is not without its critics in the primary. During the initial Democratic debates, former Maryland Rep. John Delaney argued that paying Medicare rates for all services, which the Sanders plan calls for, would cause hospitals to close, since the amounts are typically much lower than those offered by private coverage. Delaney also argued that the plan would cause union members to lose their current coverage, an idea echoed by former Vice President Joe Biden, whose own proposal calls for expanding...