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The health care industry is betting on Joe Biden in its war against Medicare-for-all

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Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

The health care industry is happy to see Joe Biden jumping into the Democratic presidential race, hoping he can be a bulwark against their true 2020 opponent: Medicare-for-all.

Many of the top Democratic primary candidates have embraced Bernie Sanders’s Medicare-for-all plan, which would essentially eliminate private health insurance.

Biden hasn’t. He also hasn’t rolled out his health care platform, as Vox’s Sarah Kliff recently wrote, but he seems likely to present a center-left alternative to single-payer.

“I’ve definitely had clients ask, where is Biden?” said Kim Monk, the managing director at Capital Alpha, which advises Wall Street investors from Washington, DC. “He’s basically an establishment candidate and would be much more in tune to building on what’s there as opposed to coming in and destroying what’s there and starting over.”

One analyst told investors amid a mild market freakout over single-payer the other day, as Axios reported: “How could the news get better? Biden wins the Democratic nomination without changing his current view against single payer.”

Industry lobbyists aren’t certain Biden will win. One Democratic health care lobbyist grimly predicted to me Sanders would take the Democratic nomination. A trade association leader brought up Biden’s two previous failed presidential bids. But they finally have a candidate in their corner with the profile to battle Sanders and single-payer.

The health care industry versus Medicare-for-all

The health care industry — doctors, hospitals, insurers, pharmaceuticals — has united in the Partnership for America’s Health Care Future, a lobbying coalition, to stop Medicare-for-all. That organization aggressively denounces single-payer at every opportunity, and has condemned proposals like a public option or letting people 55 and older buy into Medicare.

“Let’s do Alexander-Murray,” a top trade association president told me, referring to the bipartisan Obamacare stabilization plan from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) that fizzled out after Obamacare repeal failed. “Make the individual market better, which we clearly could do; it wouldn’t cost that much money.”

Industry insiders expect Biden to, at most, support a public option that allows some or all people under 65 to buy into Medicare. The Biden campaign did not respond to requests for comment on the candidate’s health care plans.

“The industry would just like to see a candidate who would be responsible and be pragmatic,” this person said. “From the industry standpoint, it’s like, what was all the energy about 2010? Biden would be more sympathetic toward that.”

Sanders has made Medicare-for-all something of a primary litmus test, and several of his opponents — Sens. Elizabeth Warren, Kamala Harris, Cory Booker, and Kirsten Gillibrand — have signed on to his bill. Not every 2020 Democrat is backing single-payer, of course. Pete Buttigieg, Beto O’Rourke, and Amy Klobuchar talk about alternative plans that don’t go as far as the single-payer system envisioned by the Vermont senator.

But it’s Biden who’s leading the polls, edging out Sanders for the most part, while the other lesser-known candidates still trail behind. He’ll position himself as the most viable center-left alternative to Sanders, the best bet to beat Trump in the general election. The primary will be Biden versus Sanders until proven otherwise, and the industry obviously views the vice president as the guy on their side.

“This encapsulates a liberal versus a moderate in people’s minds. People want to beat Trump. They know a socialist can’t. The government isn’t going to fix everything,” a Democratic health care lobbyist said. “To that extent, people are waiting for” a candidate like Biden who wants more incremental improvements.

Democratic voters do like Medicare-for-all, but the politics is complicated

We shouldn’t understate the success single-payer supporters have had in bringing the idea into the mainstream political debate. Sanders has gone from being the lone sponsor of a single-payer bill in the Senate to having a bill with 17 co-sponsors, including Warren, Harris, Booker, and Gillibrand. A full 80 percent of Democratic voters said they supported the plan in the most recent poll from the Kaiser Family Foundation.

But that survey also found that more Democratic voters said they wanted to focus on improving the ACA than said they wanted Congress to pass a national Medicare-for-all plan.

Kaiser Family Foundation

Kaiser has previously found that Democratic voters support a Medicare buy-in at a higher rate than Medicare-for-all, though more than half of them support the latter. It’s just not clear that single-payer health care is a red line for many Democratic voters yet, even if the Sanders wing is fervently behind the idea.

Other surveys have shown that Democratic voters are, for the moment, prioritizing electability above other considerations when thinking about the 2020 field. Based on the reporting that led up to Biden’s entry into the fray, these concerns about electability are a big reason he’s getting into the race.

That’s good news from the health care industry’s perspective. “If Biden can do it, take off and be a liberal pragmatist, that’s a good thing from most of our standpoints,” said the trade association leader.

But that person also made note of Biden’s failed presidential runs in 1988 and 2008. Uncle Joe isn’t being treated as a white knight to save the industry from the nationalizing hands of Bernie Sanders — their great fear is either their complete elimination or cuts to payments, both treated as existential threats — so they see themselves as at war with Medicare-for-all itself. It’s bigger than a specific candidate.

“The insurers would much rather have Biden than Warren, Sanders, or a couple of others. However, right now, they’re focusing their attention on the policy and politics of Medicare-for-all and not spending much time thinking publicly about which candidate they prefer or pushing one candidate over another,” another lobbyist told me.

The health care industry does generally seem to see Biden as their best chance to stop Sanders, or Warren or any of the other Medicare-for-all supporters. At least one high-profile guest at the vice president’s first big fundraiser is reported to be a health care executive.

“He’s the only bet,” the Democratic lobbyist said. “He’s the only person that’s anyone.”