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Democrats confront divisions over health care in debate

WASHINGTON — It was a command as much as a question, intended to put an end to months of equivocating and obfuscating on the issue: Which of the Democratic presidential candidates on the debate stage supported abolishing private health insurance in favor of a single government-run plan? Show of hands, please.

Just four arms went up over the two nights — Senator Elizabeth Warren of Massachusetts and Mayor Bill de Blasio of New York on Wednesday, and Senators Bernie Sanders of Vermont and Kamala Harris of California on Thursday — even though three candidates who kept their hands at their sides have signed onto bills in Congress that would do exactly that.

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And after the debate, Harris said that she had misunderstood the question, suggesting she had not meant to raise her hand either.

The response, and ensuing confusion, reflected one of the deepest fault lines among Democrats heading into 2020 — on an issue the party hopes to use as a cudgel against President Trump as effectively as it did last fall, when Democrats’ vow to protect the Affordable Care Act helped them recapture the House.

Though Democrats owned the health care issue in 2018, pointing a way forward— tear up the current system and start over or build on gains in coverage and care that the Obama health law achieved — is proving tricky for the party’s presidential candidates.

The challenge is to avoid alienating both the progressives, whose support they will need in the primary, and the more moderate voters, without whom they cannot survive the general election.

In raising her hand on the debate stage Wednesday and saying, “I’m with Bernie,” Warren seemed to have made the calculation that proving herself as unequivocal as Sanders in the quest for universal government-run health insurance was crucial to building left-wing support.

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During the early months of the Democratic primary race, Warren has gained attention with her steady stream of detailed policy plans. But before Wednesday’s debate, she had been less than crystal clear about how she would expand access to health care — and particularly on the role that private insurers should play under the type of Medicare-for-all system that she is calling for.

“I think lots of progressives were very happy to see her clarify her position,” said Waleed Shahid, the communications director for Justice Democrats, a group that seeks to elect progressive House candidates.

Harris had more overtly waffled on the future of private insurance before the debates, yet raised her hand just as quickly as Sanders when one of the moderators asked who favored abolishing it.

After the debate, she immediately walked it back, saying she understood the question to be asking whether she would give up her own private insurance.

Asked point-blank on MSNBC’s “Morning Joe” on Friday morning whether she believed that private insurance should be eliminated in the United States, Harris responded, “No.”

“I am a proponent of ‘Medicare for All,’ ” she said. “Private insurance will exist for supplemental coverage.” Sanders’ Medicare for All Act, which she cosponsored, would allow private coverage for elective procedures, like cosmetic su rgery, not covered by the government plan.

John Delaney, a former Maryland congressman who is also seeking the Democratic presidential nomination, warns that the party is at risk of turning health care into a liability.

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“We won on health care in 2018, and if we go down the path with Medicare for All, we’ll lose on it in 2020,” he said in an interview.

“Right now, about half of our citizens have private insurance and most of them like it,’’ he said. “And you just can’t win elections on taking something away from the American people that they like. It’s just not common sense.”

Ironically, support for universal government-run health insurance could provoke the same counterattack from Republicans that the Democrats used so potently after the Trump administration tried to repeal and replace the Affordable Care Act.

“Trump and the Republicans will spend a billion dollars telling the American people that the Democrats want to take away your health insurance,” Delaney said, “and he would be correct.”

Trump appears to be adopting just such a strategy. In a recent Rose Garden appearance, he warned that more than 120 Democrats had cosponsored Sanders’ Medicare for All bill — “a massive government takeover of health care,” as he put it — that would expand Medicare to cover all Americans, make the program’s benefits more generous, and eliminate most deductibles and copayments.

“Their plan would eliminate Medicare as we know it and terminate the private health insurance of 180 million Americans,” Trump said.