A guide to following the health debate in the 2020 elections

Health has been a top issue in the presidential campaign during the past year: Not only do the Democratic candidates disagree with President Donald Trump, but they also disagree among themselves.

Voters have frequently complained that the debate has been confusing and hard to follow. Most of the attention so far has been focused on whether the U.S. should transition to a “Medicare for All” program that would guarantee coverage to all U.S. residents — and result in higher taxes for most people. But there is far more to the health debate than that.

The campaign is nearing some key moments — the caucuses in Iowa next week, the New Hampshire primary Feb. 11, voting in Nevada and South Carolina later in the month. By March 3, Super Tuesday, Democrats will have chosen a third of all delegates. Here are six things to know as you tune in to the increasingly frenzied primary race.

  1. Universal coverage, Medicare for All and single-payer are not all the same thing. Universal coverage is any method of ensuring that all of a country’s residents have health insurance. Other countries do it in various ways: through public programs, private programs or a combination.
  2. Voters are more concerned about health care costs than health care coverage. While Democrats fight over how best to cover more people with insurance, the majority of Americans already have coverage and are much more worried about the cost. A recent survey of voters in three states with early contests — Iowa, South Carolina and New Hampshire — found voters in all three ranked concerns about high out-of-pocket costs far ahead of concerns about insurance coverage itself.
  3. It’s the prices, stupid. There’s a good reason voters are so concerned about what they are being asked to pay for medical services. U.S. health spending is dramatically higher than that of other industrialized nations. In 2016 the U.S. spent 25% more per person than the next highest-spending country, Switzerland. Overall U.S. health spending is more than twice the average of other Western nations.
  4. Drug companies and insurers aren’t the only ones responsible for high prices. To listen to many of the candidates’ messages, it may seem drug companies and health insurers are together responsible for most — if not all — of the high health spending in the U.S.
  5. Democrats and Republicans have very different views on how to fix health care. To the extent health has been covered in the presidential race, the story has been about disagreements between Democrats: Some want Medicare for All, while others are pushing for less sweeping change, often described as a “public option” that would allow but not require people to purchase a government health plan.
  6. There are important health issues beyond insurance coverage and costs. Some candidates have talked about long-term care, which will become a growing need as baby boomers swell the ranks of the “oldest old.” Several have addressed mental health and addiction issues, a continuing public health crisis. And a few have laid out plans for the special needs of Americans in rural areas and those with disabilities.