World·Analysis

How the U.S. Medicare generation squashed the Democrats' Medicare for All candidate

One under-discussed story of the 2020 U.S. election involves health care and the generational divide. Older voters already have universal public health care, and they've crushed the candidacy of Bernie Sanders, who is running on extending that program to everyone.

Democrats' presidential nomination race is a story of generational divide, where one side has health coverage

Sen. Bernie Sanders is the overwhelming favourite in this year's primaries with younger Democrats, like this supporter at a recent rally in Texas. He's losing badly because older voters overwhelmingly prefer the more centrist Joe Biden. (Callaghan O'Hare/Reuters)

A generation of older American voters that already has universal Medicare access is squashing the Democratic presidential candidate who promises Medicare for others.

It's one of the most striking, arguably underdiscussed, stories of the 2020 U.S. election so far, involving a generational divide and, when it comes to health care, America's haves and have-nots.

It's also shading the political debate over the novel coronavirus.

People over 65 have long enjoyed public health coverage under the popular social program called Medicare — and they're clobbering the candidate for the Democratic presidential nomination whose signature promise is Medicare for All: Sen. Bernie Sanders.

Sanders was rejected by a whopping three-quarters of voters over age 65 in recent primary races. Barring a miraculous reversal starting in tonight's batch of primaries, he is almost guaranteed to lose the nomination.

Younger voters who support Sanders aren't pleased.

Biden talks with CNN anchor Dana Bash as Sanders waves after they participated in a Democratic presidential primary debate on March 15. (Evan Vucci/The Associated Press)

That includes Sandy Barnard, who volunteered for Sanders in California, knocking on 150 doors and making 250 calls per week. 

She said she'd still vote for Joe Biden if he's the nominee but would not expend energy volunteering for him.

"Frustrated" is how the 24-year-old described her reaction to the state of the race. "There is a social safety net for the old. … They have it — and other people want it, too."

She said the coronavirus only adds to the frustration. 

Sanders has been linking the crisis to a longer-term issue: that some Americans might avoid treatment out of fear of medical bills and wind up spreading disease.

"That's a public-health issue," Barnard said. 

"I know people with coughs for a long time, but they don't ever get seen. I know people who have little bracelets that say, 'Please don't call an ambulance for me — I can't afford it.'" 

Health care: An American snapshot

To put things into perspective, most Americans have better care. 

One thing many foreigners might not realize is that an overwhelming majority of Americans have health coverage — about 91.5 per cent, and most say they're happy with it.

No generation is better covered than seniors over 65.

Americans mainly get coverage in one of three ways

Two-thirds have private insurance, primarily offered through their employer. The remaining one-third is mainly split between public programs created in 1965: Medicare, for senior citizens, and Medicaid, for low-income people.  

Supporters of Sanders's Medicare for All plan at a 2019 event in Washington where Sanders proposed a bill to extend to all Americans access to Medicare, currently available only to seniors. (Aaron P. Bernstein/Reuters)

Former prime minister Stephen Harper once pointed out this large swath of socialized medicine when an American conservative pundit questioned him about the differing health-care attitudes in the U.S. versus Canada.

"We [have a tendency to] go on stereotypes here," Harper replied.

"In the United States, every senior citizen is under socialized medicine. So, the difference is not as radical as people sometimes think."

Medicare provides basic coverage, and additional layers of coverage are available to taxpayers who pay monthly premiums starting at $144.60 US. 

What Sanders promises to do is to extend that seniors program to everyone. It would be expensive, but he says it can be funded in a variety of ways

Sanders often points to a study in The Lancet medical journal that said Medicare for everyone would reduce health costs by 13 per cent and save 68,000 lives a year.

He has also used the current pandemic as an example of how Americans would be collectively better off if everyone had guaranteed health coverage.  

Spoiler alert on Medicare for All: it's probably not happening soon. 

Leaving aside the longer-term challenge of whether Sanders's promises could ever pass Congress, his shorter-term problem is his presidential bid is sinking fast. 

He's already 20 per cent behind Biden in convention delegates, and polls suggest he's likely to get clobbered in the states voting next.

Young voters know what it's like to be uninsured

That's prompted intergenerational finger-pointing – with some annoyed millennials and gen-Zers sniping at their elders on social media.

In interviews with several young democratic socialists, CBC News didn't actually hear any trash-talking of baby boomers. 

What people did share was their frustration: with the campaign, with intergenerational inequities and with the state of American health care.

If I had had a car accident, or fallen down the steps, or gotten cancer, or anything during that time, I would probably have gone bankrupt.— Nick Conder, 29

Barnard recently spent two years without health coverage. 

She now has insurance as a municipal employee in Berkeley, Calif., but coverage only kicks in after she spends $3,000 on care.

Nick Conder, a 29-year-old Kentucky library clerk, recently went without insurance for five months after losing another job.

"It was extremely scary," he said.

"It's always just there in the back of your mind. Like every time you get in a car, it's like, 'Be very careful, because if something bad happens, I don't have health insurance.'

"If I had had a car accident, or fallen down the steps, or gotten cancer, or anything during that time, I would probably have gone bankrupt."

Conder said he went for a round of blood tests before his insurance expired — then he went back to get the blood-test results five months later, when he managed to get insurance through his spouse's plan.

Conder said he cringes when people say things like, "OK, Boomer." When he thinks of older people, he thinks of his grandparents — working-class people also struggling to get by.

But he thinks seniors just take their benefit for granted, and, like everyone, struggle to see other people's reality. 

"I don't necessarily think it's always cruelty or anything like that," he said.

Fear of socialism outdated, say some

Another young socialist just recently elected to the Virginia state legislature said he thinks older Democrats are just scared of childhood boogeymen.

Lee Carter ascribes the generational aversion to Sanders to a pair of persistent fears. 

One involves the word "socialism," which packs a powerful connotative punch among older people who grew up during the Cold War.

Folks my age and younger, we didn't grow up with Cold War propaganda.—Virginia lawmaker Lee Carter

"Folks my age and younger, we didn't grow up with Cold War propaganda. We didn't have this constant fear of the Reds, comin' to get ya," said the 32-year-old lawmaker. 

"It's incredibly frustrating, trying to explain to people that, 'Hey, here's a guy who wants everyone to have health care and housing and education.'"

Shades of McGovern

The other fear he detects in older people? A repeat of George McGovern, 1972. 

Boomers were still young the last time Democrats nominated a candidate that far left of the party establishment — and their preferred candidate was pulverized by Richard Nixon in the general election.

"People are being paralyzed by the fear of losing to Donald Trump," Carter said, explaining why many favour what they see as a safer, centrist choice in Biden.

Young voters say the older generation's outdated fears about socialism are tainting their views on Sanders's polices for equal access to housing, health care and education. (Evan Vucci/The Associated Press)

"But I feel like this fear of repeating 1972 is going to make us repeat 1980, or 1984, or 1988, or 2000, or 2004, or 2016. All these other times when the 'pragmatic choice' completely failed. It's not 1972 anymore."

Carter was also without insurance until he got elected in 2017. 

He'd had a workplace accident — he was electrocuted by 240 volts by what he says was a misplaced line.

When he was ready to return to work, he said ,he was laid off. Now, Carter has insurance as a state lawmaker, under a private plan.

He says it's still not as good as the best insurance he ever had — the public program provided to him when he was a U.S. Marine. 

"I know what's possible," he said. "I know the quality of care people can get."

Biden, Sanders agree on a lot — just not Medicare

So, what is Biden offering?

He's also promising major health reforms — just not quite as big as Sanders's. The front-runner's plan would allow people to opt into Medicare if they want it. 

Advocates of Biden's approach say it has a better chance of getting passed in Congress, with less disruption to the swath of the U.S. economy involved in health insurance.

One researcher tracking U.S. public opinion said older Democrats aren't really that polarized on the candidates: he said they actually like both Sanders and Biden.

But he finds a pretty noticeable difference on Medicare for All.

Robert Griffin researches American public opinion at the Democracy Fund's Voter Study Group, which is tracking nearly 11,500 American voters. 

He said 72 per cent of younger Democrats, age 18 to 29, support Medicare for All (it's 57 per cent of that age bracket among party supporters of all stripes).

He said 52 per cent of Democrats who are over 65 support universal Medicare (and just 33 per cent of seniors of all partisan stripes).

And that kind of gap in attitudes has made all the difference in the race to pick the Trump's challenger.

About the Author

Alexander Panetta is a Washington-based correspondent for CBC News who has covered American politics and Canada-U.S. issues since 2013. He previously worked in Ottawa, Quebec City and internationally, reporting on politics, conflict, disaster and the Montreal Expos.

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