It is the first Democratic dilemma of the 2020 campaign. Universal health care provided by the government, the so-called ‘Medicare for all” idea has emerged as a dividing line between party progressives and more moderate Democrats. The New York Times writes the activist base of the party, led by Bernie Sanders, believes not only should the government provide healthcare for all, but private health insurance should also be ended:

“But polls indicate that the broader electorate, particularly the moderate- and high-income voters who propelled the party’s sweeping suburban gains in the midterms, is uneasy about this “Medicare for all” approach in which many would lose their current insurance options and pay higher taxes.”

At a CNN town hall soon after she launched her campaign, California Democratic Senator Kamala Harris made an eye-opening remark on private health insurance saying she would “eliminate all that.” Currently, 60 percent of Americans receive private health insurance from their employer. From The Times:

“The concept of Medicare for all has become popular with Democrats: 81 percent support it, according to a recent Kaiser poll. Yet voter opposition to surrendering the insurance they are used to led to a backlash over President Barack Obama’s repeated promise that “if you like your plan, you can keep your plan” after it proved false for several million people under his health law. Many Democrats are keenly aware of that backlash, and the 2020 presidential race will be the first where many of the party’s leading candidates will have to explain and defend the meaning of Medicare for all.”

On one end of the spectrum, you have Bernie Sanders, who believes all private insurance should be eliminated, except for cosmetic surgery. On the other end, you have former New York City Mayor Michael Bloomberg who thinks the idea would be financial folly. From The Times:

“To replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time,” Mr. Bloomberg told reporters in New Hampshire on Tuesday.

NEW: 2020 Dems face their first defining policy choice: would they support ending private health insurance? @BernieSanders makes no bones about it. But others are treading carefully post- @KamalaHarris /@jaketapper

w @abbygoodnough >https://t.co/fJ6yRUQUur

— Jonathan Martin (@jmartNYT) February 3, 2019

Other Democratic hopefuls are offering a more middle of the road approach. An idea from Sen. Sherrod Brown of Ohio would lower the eligibility age for Medicare from 65 to 50 or 55:

Sherrod Brown on Medicare for all: I think that if we can make that change of Medicare at 55 or Medicare at 50, it’ll make all the difference in the world for millions of people. And then we’ll get to the next step. pic.twitter.com/WDDVQ991m4

— Vaughn Hillyard (@VaughnHillyard) February 2, 2019

Republicans are already seizing on the idea of eliminating private health insurance. GOP strategist Karl Rove writes in The Wall Street Journal:

“Democratic presidential candidate Sen. Kamala Harris made her party’s left-wing base happy this week. But in doing so, she might have made Democrats less attractive to general-election voters.”