Democrats should be happy to be divided on health care

"He's said you're going to have to raise taxes on the middle class. He says it's going to end all private insurance." Biden has proposed expanding the Affordable Care Act as his alternative, including the creation of a public option, like progressives had pushed for when the program was created. Sanders blasted the Democratic frontrunner, accusing him of making false allegations about what his program would do.

The 2020 election is now fully on the horizon, and the health care issue doesn't look like it will be going away any time soon. As the Supreme Court considers a case that could deem the ACA unconstitutional, Democrats are dividing over what needs to be done to the national system if a Democrat wins office (and the party manages to somehow take enough control away from Senate Republicans).

While some Democrats are terrified of divisions, health care has proven to be a good issue for Democrats in recent years, and the efforts of the GOP to radically dismantle the current system have been very unpopular with the public. This was a key sticking point for voters in the 2018 midterm elections.

Currently, there are three major health care alternatives on the table.

The Republican position remains repeal and replace. This is the most dangerous political position of all, which is why so many Republicans are practically begging the President to stay silent on the issue. The GOP has not put forth any substantive health care proposal other than promising something better than what exists. The radical option put forth by the GOP would destabilize the entire health care system by removing this massive regulatory infrastructure and then waiting for Congress to put forward an alternative.

Some Democrats, including Sens. Sanders, Kamala Harris and Elizabeth Warren, endorse going bold as soon as possible. In their minds, the reforms put into place under Barack Obama through the ACA did not go far enough, leaving a system still broken with all the political costs that come from any expansion of domestic policy. Too many people remain without coverage and costs are still too high. Obama was pilloried as a left-wing radical, even though his policy centered on reforming and improving the existing private health care system. The progressives in the party argue that something bigger needs to be done to make sure that all Americans receive coverage at a fair cost. They want to expand Medicare into a national insurance program. If Congress changed the program, they would fulfill the vision of the original founders, who always thought that Medicare for seniors was just a first step.

Affordable Care Act gears up for momentous test in court

Biden is seeking a different path. While sharing many of the objectives of his fellow Democrats, Biden argues that building on what already exists (though Medicare supporters would argue they are doing the same) is the best way to go. The health care initiative that the Obama administration passed -- which Biden famously called a "big f***ing deal" -- offers the bones, so he says, for something even bigger. "ACA for all" might be his catch phrase. In practice, as the Washington Post's Paul Waldman noted, the Biden expansion is quite bold, embracing many of the ideas that had been considered "radical" in 2009-2010. Still, Biden is trying to package his plan as a middle way, an incremental approach to reform, which is part of his overall effort to claim the centrist lane in party politics.

As long as all three proposals are in the mix, Democrats are in good shape.

Which plan wins is anyone's guess.

But the fact that the debate is taking place is a good thing. Democrats fighting over health care will keep the issue in the public mind. While there are risks that Medicare for All can become a tool for President Donald Trump to paint his opponents as far left, there's the potential for Democrats to demonstrate that the GOP is in fact the most radical party of all -- constantly pushing to eliminate federal protections and subsidies that millions of Americans have come to rely on.

This is one debate Democrats should be delighted to have.

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