With Medicare for All on the Table, Iowans Are Caucusing for Their Lives

Democrats in Iowa are voting for their lives as they gather for the presidential caucuses today. Besides beating President Trump, polling shows that health care is the top issue among likely caucus-goers. The vision of a Medicare for All system that provides health insurance to everyone has energized activists and the party’s progressive base.

Last week, as Democratic presidential hopefuls were scrambling to persuade Iowa voters ahead of today’s influential primary, 30 activists stormed Joe Biden’s campaign office in Des Moines and demanded to meet with the former vice president or a top campaign manager. The activists said Biden has spread “lies” about Medicare for All, citing alarming and inaccurate statements that echo talking points promoted by opponents in the private insurance and health care industries. For patients struggling to pay medical bills under the nation’s for-profit health care system, the issue is a matter of “life and death,” activists said.

“Right now people should not be thinking about, ‘we can’t do this or we can’t do that,’ they should be demanding what we truly deserve in this moment, in this political crisis, and what we deserve is a health care system that’s for putting us before profits and not for filling the pockets of CEOs,” said Jack Reardon, an organizer with Iowa Citizens for Community Improvement, one of the groups behind the protest.

The protesters chanted, sang and shared stories about the pain caused by the current health care system. One activist had declared bankruptcy after struggling to pay for treatments that saved his daughter from thyroid cancer. A member of Iowa Student Action, a group that supports Medicare for All and free college tuition, lost a sibling who could not afford treatment for substance dependence to suicide.

“It’s a deeply personal issue,” said Reardon, who was one of five activists arrested by police and released after being cited for trespassing.

Indeed, the health care debate has dominated the Democratic primary in Iowa and beyond. Last week, “abortion” and “health care” were the top two Google searches in Iowa related to Democratic presidential candidates, according to Axios. Like the other moderates in the Democratic field, Biden supports “strengthening” the Affordable Care Act with an optional government insurance program rather than providing Medicare for All. His disparaging statements about Medicare for All have won his campaign support from private health industries determined to protect their profits — and raised ire among progressives, young people and activists.

“Ultimately, to us, what that says is, ‘wow, [Biden] is showing that he is more accountable to those CEOS and to those lawyers, to the people funding his campaign who have made a profit off the suffering of our loved ones and family and friends; he’s more interested in being accountable to them than everyday working class Iowans, whether they are white, Black or Brown,’” Reardon said.

The other two frontrunners, Senators Bernie Sanders and Elizabeth Warren, both support Medicare for All, although they have different ideas about paying for the program and disagree about how quickly to roll it out.

Sanders has pledged to introduce Medicare for All legislation in the first week of his presidency, while Warren wants Medicare for All by the third year of her presidency after using a “public option” as a political stepping stone. Of course, Congress must debate and act on any significant change to the health care system. Sanders is running on his consistent support for a national, single-payer health plan over the years, while Warren is framing herself pragmatic and electable.

Sanders’s consistency is paying off in Iowa, where the democratic socialist enjoyed a surge in the polls leading up to the caucuses. An Emerson College poll found last week that 35 percent of likely caucus-goers said Sanders has the best health care policy among the top 10 candidates, with Biden and Warren trailing at 21 percent and 14 percent, respectively.

The same poll found Sanders leading Biden for the nomination by nine points, but other polls suggest the race remains tight and unpredictable.

On Wednesday, a Monmouth University poll found Biden with a four-point lead over Sanders in a four-way contest. However, only 47 percent of those polled had firmly decided on their candidate, a number that has not grown much in weeks. Another 45 percent said they are open to switching support from one candidate to another at their caucus, with 13 percent saying a switch was a strong possibility.

Reardon, who plans to vote for Sanders, said voters across the state are energized by the health care debate and the prospect of Medicare for All. Iowa Citizens for Community Improvement began organizing around health care in early 2017 when Trump and congressional Republicans attempted to repeal the Affordable Care Act, and its campaign and membership has grown ever since.

“And this is just one example of many,” Reardon said. “You can see that people are willing to go to great lengths to make sure that we can have a health care system that actually treats people instead of treating them as centers for profit.”

Iowa Citizens for Community Improvement endorsed Sanders last month, but Reardon said the protest at Biden’s office was about Biden, not Sanders, and their organization did not collaborate with the Sanders campaign. The campaign also targeted Pete Buttigieg, the former mayor of South Bend, Indiana, who supports a public option rather than Medicare for All, but Reardon said Buttigieg engaged with the group and answered their questions. Biden did not.

While not directly connected to the Sanders campaign, these Iowans’ activism is evidence that Sanders’s second run for the White House reflects grassroots movements and is a movement in and of itself. That Sanders’s “political revolution” is fueled by millions of working people, not the wealthy and big corporations, is central to the senator’s message and has been a notably successful fundraising strategy. The Iowa caucuses will be an early indicator of whether Sanders’s movement-building strategy can pay off at the polls.

If Sanders does well in today’s primary, it will also be a good sign that Medicare for All is the winning issue his campaign hopes it to be. Like the protest at Biden’s campaign office, Sanders often asks audience members at his campaign events to share stories about their personal struggles to afford care under the for-profit system dominated by private insurance. Sanders is betting he can harness this discontent nationwide to win the White House. After all, almost no one on a budget is thrilled about insurance premiums and copayment schemes, regardless of their political views.

Polling on Medicare for All is complicated. A slim majority supports the idea and even more want at least a public option, but views among voters tend to shift depending on how pollsters and politicians frame the issue. Still, it’s clear that a significant majority of Democrats and many other voters want serious change. In fact, nearly half of all voters and the vast majority of Democrats support both a public option and Medicare for All, according to a Kaiser Family Foundation poll released Thursday.

However, the Iowa caucuses give voters a clear choice between those who favor Medicare for All — Warren and Sanders – and those who don’t. There’s a long primary season ahead, but Iowa will provide an early glimpse of how Democratic voters respond when every candidate before them declares that health care is a human right, but only two would guarantee that right to everyone.