Biden vs Bernie: What Are Their Stances On Healthcare?

The Democratic primary is down to two candidates, and healthcare is key on the ballot. Both agree it must be fixed, but beyond that their solutions are glaringly different.
Joe Biden and Bernie Sanders (Official Photos)

Joe Biden and Bernie Sanders (Official Photos)

Bernie Sanders’ healthcare plan

Bernie Sanders is an ardent proponent of Medicare for All. For him, health care is a basic human right, not an entitlement. Arguing that if all the other major countries on the planet can provide health care at low to no cost, America should be able to do the same.

Sanders authored the 2019 Senate Medicare for All bill, which calls for universal, single-payer government coverage that would replace the for-profit healthcare industry. His plan would eliminate point of service fees, networks, premiums, deductibles, copays, and surprise bills. It would cap what Americans pay for prescription drugs at $200 per year. Coverage would go far beyond the basics that Medicare currently covers, including dental, vision, hearing, long-term care, reproductive and maternity care, substance abuse treatment, and mental health services.

Bernie Sanders’ record on healthcare

Bernie Sanders has been remarkably consistent in his approach to healthcare throughout his career in Congress. For him, it’s either universal single-payer, or not worth making a change. Nowhere was this more evident than in the Obama administration’s battle to design, pass, and enact the Affordable Care Act, and his attitude towards it currently. For Sanders, the ACA was just more of the same, kowtowing to the pharmaceutical and for-profit healthcare industries. He sees it as a kind of pact with the corporate devils. It gives a little, but it keeps people enslaved to “the system.” He did, in fact, ultimately vote for it. But he protested all the way.

Fast forward to the current moment. Bernie’s argument with every other candidate he has competed against in the Democrat primary season has been that the ACA does not go far enough. And that it is not worth fixing. It should be eliminated and replaced with his plan. That sounds good in a stump speech. Who among us wouldn’t want what he is promising? But the larger question, which he has yet to answer, is how it would be paid for. His rhetoric on this point has been less than direct. The argument goes “well, every other major country in the world does, there’s no reason why we can’t.”

But, do they? Do they really have universal health care paid entirely by the government? In fact, no. Most of them do not. All of them have some version of government-sponsored healthcare, but in most countries, people still pay, as well as having higher taxes. The bottom line is, it is just not as simple as Bernie Sanders is making it out to be. And many cost estimates of his plan come out in the tens of trillions over ten years. How will we pay for it? He has recently admitted he doesn’t know. “We’ll figure it out.”

It’s for you the voter to decide if it makes sense whether to dismantle the healthcare industry as we know it today, amounting to one-fifth of the US GDP, on this basis.

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Joe Biden’s healthcare plan

Joe Biden is firmly committed to keeping the ACA as a baseline plan. Instrumental in its creation and passage during his terms as Obama’s Vice President, he knows its strengths and its weaknesses. He has argued that it was always just a beginning, the best that could be done with so much Republican antagonism. For Biden, the task is not to raze the healthcare and pharmaceutical industries to the ground and replace them with government-run programs. He wants to build on the improvements that the ACA has already made, expand coverage, and fix what’s broken. He also wants to reverse the deleterious effects the Trump Administration has had on how many people the ACA covers. His plan is to get more than 97% of Americans covered.

What does that look like? Basically, the Biden plan is a public option that will be available regardless of insurance status. That means that those who are uninsured, or insured through their employers, or self-insured will all be eligible for his plan. He promises to eliminate co-pays for primary care and limit what Americans pay for insurance coverage to 8.5 percent via tax credits. His plan covers low-income people in states that have not adopted the Medicaid expansion, and states that have adopted it will have the option of broadening coverage based on income level. He also proposes to tackle the issue of high drug prices by limiting what pharmaceutical companies can charge, and allowing Americans to purchase their drugs from other countries.

Biden’s plan doesn’t stop there though. He’s clearly thought a lot about how to restore and promote equity for at-risk populations such as the LGBTQ community, and women’s reproductive rights. He supports codifying Roe v Wade and restoring federal funding for Planned Parenthood, doubling the federal investment in community health centers, and expanding funding for mental health services.

Joe Biden’s record on healthcare

Biden was Vice President in the Obama Administration, and the Affordable Care Act was that administration’s baby. For those who hate the ACA, that’s a mark against him. For those who love it, that’s a career-defining accomplishment. Interestingly, Biden joined other liberal Dems who advised Obama to put off his healthcare agenda until he got the recession taken care of. That does not mean that Biden was anti-healthcare reform. Quite the contrary. He and the others just felt that as a new president, Obama might be biting off more than he could chew. Biden himself had offered what was then a pretty progressive healthcare plan when he ran for president in 2007.

Once the president made it clear that he was not to be moved, Biden got on board, and the rest was history. It wasn’t clear, early on in his 2020 candidacy, where he stood on healthcare. He appeared to waffle, not coming out in favor of Medicare for All but not discounting it either. As he got his land legs, he clearly spent a lot of energy working up a detailed plan that would be distinct for him, that would include progressive ideals, while also maintaining what he and his colleagues had already accomplished with the ACA.

That said, Biden has a checkered record with respect to policies that progressives hold dear, and has come under attack for those. On the subject of healthcare specifically, he originally voted in favor of the Hyde Amendment, which bans federal funds for abortion, only reversing himself on that issue in 2019 as a presidential candidate. He also voted for an amendment that would have allowed states to overturn Roe v Wade, only to change his mind and vote against it the following year. And although on his website he says that healthcare is a right, not a privilege, his plan uses the rhetoric of providing “access” to healthcare, which is not the same thing as providing actual healthcare.

How you read these varying positions and this rhetoric is really up to you. Does it mean he flip-flops on key issues and can’t be trusted? Or does it mean that he is a thoughtful public servant who is willing to listen to his constituents and the American people, and to change his position when the cultural currents demonstrate that times have changed and a new approach is warranted?

A side-by-side comparison of policies

Without getting too deeply into the weeds, we’ve put together a table to show you the significant differences between the two candidates’ policies. For background, you might also check out our article Medicare for All and Public Option, Compared.

Feature Biden Sanders
Who is covered? Those who choose to be. Everybody, including undocumented immigrants.
How does coverage happen? Opt-in, or automatic if low-income and on other supports such as SNAP. Automatic for everybody.
Can I keep my current insurance? Yes. No. Private insurance will no longer exist.
What will coverage cost me? Capped at 8.5% of your income, via tax credits. Nothing.
What if I’m low income or not quite low-enough income for Medicaid? Builds on Medicaid Expansion: if you’re in a state that has adopted it, their eligibility requirements may be softened. If you’re in a state that didn’t adopt it, you will now be covered assuming you meet the eligibility. Not an issue. Everyone is covered and Medicaid goes away.
What about deductibles, co-pays, and other out of pocket charges? No co-pays for primary care, and the rest is handled through task credits. No out-of-pocket expenses of any kind, ever, except some prescription drugs.
What happens to prescription drug prices? Negotiated with pharmaceutical companies for lower prices; ability to buy from other countries. Capped at $200.
What is covered? Everything ACA covers. Everything the ACA covers, plus Vision, Dental, Mental Health, Reproductive Care, Long-term Care.
What if I have a pre-existing condition? You’re covered and insurance companies can’t raise your rates or deny coverage. You’re covered.
Will my taxes go up? Biden plans to roll back the Trump tax cuts for the wealthy, and eliminating capitals gains tax loopholes. Other than that, it’s unclear. Yes.

The Rantt Rundown

Healthcare is on the ballot, big time. The two remaining contenders for the Democratic presidential ticket have quite significantly different views about what to do. Bernie Sanders, a long-time champion of universal, single-payer healthcare, has put his Medicare for All plan at the center of his platform but seems unclear about how he will pay for it. Joe Biden is all in for expanding on the ACA, but his voting record is a tad spotty on healthcare and it’s not clear how much of a difference his plan will make. Both plans seek to expand healthcare while Republicans have sought to take away healthcare from millions. Now that you’ve gotten a taste of the differences, what do you think?

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Rantt 101 // Bernie Sanders / Democratic Primary / Healthcare / Joe Biden