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No one knows what Joe Biden thinks about health care

Biden has not endorsed Medicare-for-all, nor has he disavowed the idea. The best we can do, then, is look back at his record on health care.

Joe Biden Speaks To Striking Stop & Shop Workers In Massachusetts
Former Vice President Joe Biden arrives in front of a Stop & Shop in support of striking union workers on April 18, 2019 in Dorchester, Massachusetts.
Scott Eisen/Getty Images

Trying to figure out what Joe Biden thinks about health care is not an easy task.

Most other prominent Democrats, including those vying for the nomination, are out stumping for single-payer. Even Biden’s former boss, Barack Obama, has described Medicare-for-all as one of the “good new ideas” that Democrats are running on.

The former vice president, who announced his presidential candidacy Thursday morning, has stayed pretty mum on the topic. He has not endorsed Medicare-for-all, nor has he disavowed the idea. His spokesperson did not respond to a request for comment on Monday on Biden’s views on health care. And his new campaign website offers sparse details. In a section titled “Joe’s Vision,” here’s what it says about his stance on health care.

The best we can do, then, is look back at the vice president’s historical health care record.

When Biden ran for president in 2007, he did have his own health care plan. He proposed expanding programs that cover low-income children, letting older Americans (those above 55) buy into Medicare, and creating a new government program that younger, uninsured Americans could purchase.

This was a pretty different, pre-Obamacare era. It was a time when a plan like that would have seemed a lot more disruptive and radical than it does right now. In the past decade, the politics of health care have shifted significantly to the left among Democrats — and Biden has not said anything about whether he is part of that shift.

Serving as vice president, Biden ended up cautioning President Barack Obama against trying to tackle health care at the start of his presidency.

This was a big debate within the White House: Should a new president really tackle a massive policy push just at the moment the country was digging out of a recession? In his book The Promise, journalist Jonathan Alter describes how Biden sided with Chief of Staff Rahm Emanuel in cautioning against taking on major reform and instead pursuing more incremental steps:

Whether or not to pursue major health care reform in the first year had been a furious topic of debate going back to the transition. ...

[Biden] said in a meeting during the transition that the Americans he and Obama had met on the campaign trail would understand if health care reform had to be delayed because the government was busy avoiding a depression. “They’ll give you a pass on this one,” he told the president. Liberal Democratic senators like Chuck Schumer and Byron Dorgan strongly urged Obama to hold off and focus on the economy.

We of course, in hindsight, know how this story ends. President Obama did decide to pursue a major health reform bill — and Vice President Biden becomes an ardent supporter of Obama’s push, as made clear by the f-bomb he accidentally dropped within range of a podium.

Since leaving office, Biden has criticized the Trump budget for making deep cuts to Medicare and Medicaid. He’s spoken at rallies defending the Affordable Care Act as Republicans were trying to repeal the law (and, according to one Washington Post report, even lobbied Sen. John McCain (R-AZ) to vote against repeal).

But he hasn’t talked much at all about what a Biden health care agenda might look like. I think it’s safe to say from his 2007 presidential plan that he would, at minimum, be likely to support a Medicare buy-in for older adults. This would be similar to the Medicare buy-in that Sen. Debbie Stabenow (D-MI) has introduced in the Senate, and which you can read a bit more about more on Vox.com.

It’s notable to me that the Biden Foundation, a nonprofit helmed by the former vice president, has a section on the various issues it considers “pillars.” That includes things like “advancing community colleges” and “strengthening the middle class.” But there isn’t a mention of health care in sight.

Wall Street, for what its worth, seems bullish on the idea that Biden won’t take on Medicare-for-all. Health care stocks have been having a tough week lately, as more talk of Medicare-for-all plans heats up. A plan like Sanders’s, which all but eliminates private health insurance, would obviously be quite bad for private health insurers and their investors.

But there is something that would help those health care stocks, J.P. Morgan analyst Gary Taylor wrote in a note (first reported by Axios) to investors last week. “How could the news get better?” he starts. “Biden wins the Democratic nomination without changing his current view against single payer.”

Taylor, in my view, overstates Biden’s position a bit — I don’t think we’ve seen him come out as anti-single payer yet. Still, his general view seems to be right: When you look out at the field of Democratic contenders, Biden right now is positioning himself as the candidate who isn’t jonesing to go big on health care.

And that, as one former vice president might say, is a big fucking deal.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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