DES MOINES — A little over a month ago, despite putting on a brave face publicly, Bernie Sanders’ aides privately concluded that a shakeup was needed for his presidential campaign.
The Vermont senator had neglected to practice in mock sessions before the first 2020 debate, and failed to aggressively take on former Vice President Joe Biden on stage. On the trail, he was sticking to the old hits: His stump speech sounded remarkably similar to the one he delivered in his first presidential bid, and he gave a major address touting democratic socialism that mirrored his talk on the same subject in 2015. Even some of his diehard supporters wondered how he would distinguish himself in a crowded field of candidates, especially when many claimed to embrace his left-wing ideals.
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Now, Sanders and his team have settled on a new strategy designed to make him stand out in the massive field: They’re betting that a renewed focus on his signature proposal of “Medicare for All” is the key to jump-starting his candidacy and overtaking Biden as the race ramps up this fall.
Sanders has raised more money and has more donors than any other candidate in the Democratic primary — upwards of $36 million from over 850,000 people. But as support in some national and early-state polling stalled or gradually eroded after Biden jumped in the race, it became clear that what worked in 2016 in a one-on-one primary against a moderate wouldn’t necessarily succeed in a multi-candidate race with more than one progressive.
Over the past several weeks, his staffers have organized a flurry of events centered around the failures of the current health care system and highlighting his role as the author of the main Medicare for All proposal in the Senate. His aides also brainstormed before the second debate to establish a game plan to put Medicare for All at the center of the showdown.
Sanders told POLITICO he is now talking about Medicare for All more than ever before and that he sees it as the “defining issue” of the 2020 campaign.
“It could be the winning issue for me in the primary, it will be the winning issue for me in the general election,” he said. “I’m campaigning on the legislation that I wrote. As you know, I wrote the damn bill,” he added, referencing his quip from the second debate that went viral.
Campaign staffers argue the new tack is working, pointing out that Sanders received the biggest polling bump (1.8 percent) of any candidate after the second debate, according to an analysis by FiveThirtyEight. That was especially encouraging given that health care dominated much of the conversation.
But the focus on Medicare for All does come with risks. Some recent polls show that a public option — essentially an ability to buy into Medicare, which Biden supports — is more popular than the sweeping single-payer proposal that Sanders backs. Several 2020 rivals have also argued that any candidate who supports Medicare for All is unelectable given the disruption it would cause for people who like their private insurance.
But the Sanders campaign believes they are seizing on his natural strength. Primary voters already see Sanders as the strongest Democratic candidate on health care, usually followed by Biden and Elizabeth Warren, according to recent polls by Morning Consult, Reuters-Ipsos, Washington Post-ABC News and CNN.
“Health care is the No. 1 issue with voters, especially Democratic primary voters, and Bernie is the most trusted candidate on health care,” Sanders’ pollster, Ben Tulchin, said in an interview. “So it became increasingly clear over the last few months, as the campaign talked more and more about it, that health care was a real strength and opportunity for us to focus on. And as a result of doing that, we’ve gained in the polling.”
Nina Turner, a co-chair on the Sanders campaign, said his team was by no means ignoring Medicare for All earlier in the primary. “But it’s his signature issue and he needs to go all in on that, and the polling shows that,” she said
The strategy has begun to take form over the past several weeks. Sanders has rallied with protestors in Philadelphia over a hospital closure, given a high-profile speech about Medicare for All in Washington, D.C., and traveled across the border into Canada with two buses full of reporters and diabetic patients looking to buy lower-cost prescription drugs.
“To be honest, I wasn’t taking notice of Bernie Sanders before,” said Rachael Lockwood, a Michigan-based mother of three diabetic children who rode with Sanders to Canada but hasn’t decided yet who she is voting for in the Democratic primary. “I’m definitely paying attention now.”
The Sanders campaign is also considering doing additional Medicare for All events, such as health care-focused town halls in the early states. “I wrote the damn bill” — his rejoinder at the second debate to criticism of Medicare for All — has become a campaign rallying cry, fit with printed stickers.
Beyond playing to the candidate’s sweet spot, Sanders’ team believes that Medicare for All provides a sharp contrast in a large field — and is an issue he knows inside and out — at a time when several surveys show health care is a top concern among voters. Though he has pushed for Medicare for All for decades, his aides think it is critical to remind voters of that fact — and that they can use his health care-related campaign events to shape media coverage of the race.
Advisers also say the new focus especially allows Sanders to distinguish himself from Biden, who is opposed to Medicare for All, and could eat into Biden’s support. Despite coming from opposite wings of the Democratic Party, polling shows there is significant demographic overlap between Biden and Sanders backers, particularly among white voters without a college degree. Biden’s voters often list Sanders as their second choice.
“The health care discussion allows us to highlight a number of differences between Bernie Sanders and Joe Biden,” said Jeff Weaver, a senior adviser to Sanders. “Obviously health care, but it’s also a willingness to take on special interests and a willingness to act decisively to lower prescription drug prices by half, and speaks to broader themes of whose side people are on.”
The new strategy was put to use in the second debate late last month. The campaign’s plan was to use John Delaney and John Hickenlooper as anti-Medicare for All foils. They served as stand-ins for Biden, too. And by making his health care-focused trips to Canada and Philadelphia before the second debate, as well as battling with Biden over Medicare for All, Sanders’ aides believe they made it more likely that moderators would focus on the issue.
They were aided by Kamala Harris, who released her own health care plan shortly before the event. Harris’ campaign claimed that its proposal also constituted Medicare for All, and the Sanders campaign pounced, with campaign manager Faiz Shakir emailing supporters that “[h]er plan is centered around privatizing Medicare, enriching insurance executives and introducing more corporate greed and profiteering into the Medicare system.”
Harris’ proposal lets private insurers compete with the government-run system and takes 10 years to implement, whereas Sanders proposal essentially replaces private insurance with Medicare in four years.
“You can call something anything you want, but the bill that I wrote is guaranteeing health care to all people,” Sanders said. “It is eliminating all premiums, deductibles, co-payments, out-of-pocket expenses. It is allowing people to walk into any hospital or doctor’s office they want.”
Along with moderates who argue that Sanders’ embrace of Medicare for All makes him unelectable, some on the left are also skeptical about his new strategy. A delegate for Sanders in 2016, who asked to remain anonymous, questioned if the renewed focus on health care would actually help him contrast himself against anyone other than Biden. Warren, in particular, has said she’s “with Bernie” on Medicare for All. And Harris continues to characterize her plan as Medicare for All despite the Sanders’ teams protestations.
“If everybody’s using the same rhetoric, do people actually dive down into the weeds to understand the difference?” asked the former delegate. “If everyone is saying these insurance companies are ripping you off and we’re going to have universal coverage for everyone, and the theory is that what people are looking for is someone to defeat Donald Trump, I’m not sure the distinction is that easy on health care.”
But Sanders’ team is confident that voters will recognize the difference between him and his opponents.
“Look, there are enormous issues out there,” Sanders said in the interview. “[B]ut I think that the defining issue of this moment in America is whether or not we have the courage to take on the health care industry, which made $100 billion in profits last year, and move toward a Medicare for All, single-payer program, which will provide health care for all without deductibles, without co-payments, without out-of-pocket expenses, without premiums.”