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SALEM, N.H. — Before hundreds of potential voters in the “Live Free or Die” state, presidential hopeful Pete Buttigieg launched into a commentary about freedom.

Freedom in health care, he said recently at Salem High School, means allowing people to choose between a government-run health plan and private insurance.

“We make it available to every American who wants it, and we set it up so every American can afford it — but I’m not going to order you to take it,” Buttigieg said of his plan, which he calls Medicare for All Who Want It.

Earlier in the day, he told supporters in Manchester: “We’re not going to kick you off your private plan if you don’t want to be kicked off your private plan, because I trust you to figure out what the right plan is for you.”

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It was an appeal to voters who are leery of a monumental restructuring of the US health care system — but also a clear swipe at one of his chief rivals, Senator Elizabeth Warren of Massachusetts.

The millennial mayor from South Bend, Ind., who has been rising in the crowded field of Democratic presidential candidates, is proposing to make health care more accessible and affordable by allowing people to enroll in a new Medicare-like plan that would compete with private insurance plans.

Warren has been pushing a national Medicare for All plan that would replace the system of private insurance that exists today.

Dedicated voters jumped out of their seats as Pete Buttigieg wrapped up his speech at the start of his New Hampshire bus tour.
Dedicated voters jumped out of their seats as Pete Buttigieg wrapped up his speech at the start of his New Hampshire bus tour.Erin Clark for the Boston Globe

The debate has emerged as a central fault line between the more moderate candidates, including Buttigieg and former vice president Joe Biden, and the more liberal ones, such as Warren and Senator Bernie Sanders of Vermont.

“On health care, the Democratic debate has largely boiled down to Medicare for everyone, or Medicare as an option,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “It’s a very simple distinction: whether people should be required to go into a public Medicare plan, or whether it should be an option.”

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The foundation’s latest poll found more support for a public option than a Medicare for All plan: 73 percent said they favored a government plan that would compete with private plans, while 51 percent said they favored a national Medicare for All plan.

Buttigieg said his proposal offers a responsible path to Medicare for All. In his view, if enough Americans choose to enroll in a public plan, private insurance eventually would fade away.

Gina Millwood and her dogs Cooper and Spencer waited for Pete Buttigieg after the mayor wrapped up his rally in a packed barn party, hosted by fellow supporters in Stratham, N.H.
Gina Millwood and her dogs Cooper and Spencer waited for Pete Buttigieg after the mayor wrapped up his rally in a packed barn party, hosted by fellow supporters in Stratham, N.H. Erin Clark for the Boston Globe

“It’s really important that we check the most extreme instincts that are out there,” Buttigieg told reporters. “If there’s a way to deliver health care that every American can access and afford for $1.5 trillion, and allowing people to choose, why would it be so important to do it for $20 [trillion] or $30 trillion and not allow people to choose?”

“What I’m proposing is really bold,” he added. “So the question is, how is that not enough?”

Buttigieg’s comments came amid a four-day tour of New Hampshire. On Friday, as he polished off a plate of chicken fingers and fries in between events, he answered questions from reporters at length aboard his campaign bus.

The candidate said he would finance his plan by rolling back corporate tax cuts and by giving Medicare the power to negotiate prices with drug companies.

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But big questions about his health care proposal remain, including exactly what benefits his Medicare plan would cover, and how the federal government would handle potentially millions of people switching en masse from employer-sponsored health coverage into the public plan.

Warren, who has called for “big structural change” in a number of areas, has argued that a complete overhaul of the health care system is necessary to help American families who can’t afford the care they need. Her plan calls for eliminating premiums, deductibles, copays, and most out-of-pocket spending.

Pete Buttigieg reacted after smelling a brew handed to him by Nicole Carrier, Co-Founder & President at Throwback Brewery, a women-founded and locally sourced restaurant in North Hampton, N.H.
Pete Buttigieg reacted after smelling a brew handed to him by Nicole Carrier, Co-Founder & President at Throwback Brewery, a women-founded and locally sourced restaurant in North Hampton, N.H.Erin Clark for the Boston Globe

In a Nov. 1 Medium post detailing her plan, Warren said more important than offering Americans choice in private insurance plans is offering them the choice to see any doctor they want without worrying about who is in-network.

“At the end of the day, what will defeat Donald Trump is having somebody who is capable of making the case to voters,” said Adam Green, co-founder of the Progressive Change Campaign Committee, a political action committee that backs Warren.

“Elizabeth Warren is making clear that she’s on the side of regular families, not big insurance companies,” he said. “And Pete is. . . repeating insurance industry talking points.”

Health insurance lobbyists oppose Medicare for All, as well as the idea of a public option.

Buttigieg attracted enthusiastic crowds as he campaigned across New Hampshire, which hosts the first-in-the-nation presidential primary in three months.

In his trademark white shirt and navy tie, he gave stump speeches and took questions from voters in three communities Friday, finding time in between to sample a local beer at the Throwback Brewery in North Hampton.

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Several supporters said they were drawn by his youth, intelligence, and message of unity.

Joan Jantz drove up from Arlington, Mass., to see Buttigieg at a barn party in Stratham, N.H. She said she is looking for a moderate candidate and called Warren and her health care plan too extreme.

“It’s too big of a thing to tackle,” Jantz said, trying to stay warm in the back of the drafty barn.

Jantz, 65, recently became eligible for Medicare, and she opted for a private Medicare Advantage plan.

She said she liked having a choice of plans.

Dan Chase of Hampton, N.H., also said he liked the choice that Buttigieg is offering.

“I don’t want anything mandated,” said Chase, 56, as he waited to hear the candidate speak at the Rex Theatre in Manchester. “I don’t think most Americans want things mandated to them.”

Tina Kelly came to see Buttigieg in Manchester with her 17-year-old daughter, Seanna, who will be able to vote in her first election next year.

Tina Kelly is still evaluating the candidates and their health care proposals. “Anything would be better than what we have now,” she said.

“We have a good insurance plan, and we’ve had some sickness in the family, and we’ve had to pay out thousands of dollars in copays and deductibles,” she said. “It’s just not working.”


Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@
globe.com. Follow her on Twitter @priyanka_dayal.

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