It is wildly unclear whether Beto O’Rourke supports Medicare-for-all

It’s easy to find clips of presidential candidate Beto O’Rourke talking about health care. He posts about it on Facebook. It comes up at multiple town halls that he held during his 2018 Senate campaign.

What’s a lot harder is figuring out exactly what type of health care system the former Texas Congress member supports.

O’Rourke entered the Democratic primary Thursday, and a close reading of his policy positions on health care reveals he vacillates between Medicare-for-all as “the best way to ensure Americans get the health care they need” and criticism of the Medicare-for-all plans offered. He once described writing his own Medicare-for-all plan, but so far, no such plan has been made public. His presidential campaign site doesn’t yet have a section on policy proposals.

Best I can tell, O’Rourke definitely supports the idea of universal health care where all Americans have access to affordable coverage. But what exactly he means is murky.

Viewed one way, O’Rourke may just be keeping an open mind. Some of his criticisms of Bernie Sanders’s plan are interesting (he favors copayments, for instance, which are a feature of many European health care systems but not Canada’s). He mentions a “dual system,” potentially a mix of private and public insurers.

But viewed another way, his difficult-to-decipher health care views could also suggest more tepid engagement with an issue that will be crucial to the primary debate. His views on health care are, in a way, similar to his views on immigration, which the Washington Post described as “no wall, few specifics.”

O’Rourke isn’t turning up with a binder full of white papers. And to run a presidential campaign — or to run a White House — he’s eventually going to need those.

A brief timeline of how Beto O’Rourke talks about Medicare-for-all

Here’s a bit of a timeline from what I’ve been able to piece together of O’Rourke’s views on Medicare-for-all, looking at the statements he’s made and interviews he’s done over the past year and a half:

June 15, 2017: Writes a Facebook post that says, “A single-payer Medicare-for-all program is the best way to ensure all Americans get the healthcare they need.”

June 17, 2017: Writes a much longer Facebook post saying, “We need a single-payer health care system for all Americans,” but that he wouldn’t co-sponsor the House bill for single-payer health care because it excluded for-profit providers from participating in the system.

September 20, 2017: Tells the Texas Observer that he likes the Sanders bill but says he disagrees with the lack of copays and premiums for all Americans. He’d prefer that Americans kick in something.

September 23, 2017: Speaking at an event at the University of Texas, O’Rourke outlines a four-step plan for getting to universal coverage. Step one is keeping Obamacare, step two is expanding Medicaid in all 50 states, step three is a public option, and step four is something similar to Sanders’s Medicare-for-all bill.

“If we could get to the last step tomorrow, I would take it in a second,” O’Rourke said at that event. “It’s important to both be as idealistic and describe as accurately as you can the vision, the goal we want to get to, and then be pragmatic about what it’s going to take to get there.”

October 9, 2017: Jeff Stein (then a reporter at Vox, now at the Washington Post) asks O’Rourke if he would support the Sanders bill should he win his Senate race in Texas. “The answer is yes, I would,” O’Rourke tells him.

November 6, 2017: O’Rourke does an interview with the Young Turks where he talks about how to get to universal coverage. “I’m not an expert on this by any means, but the only way I understand is to have some kind of a single-payer model,” O’Rourke says. “And the best one going in the United States now is Medicare.” He goes on to talk about the possibility of starting with a Medicare buy-in that would eventually transition to a full single-payer system.

March 16, 2018: O’Rourke tells Bill Maher that health care is his No. 2 policy priority.

“Universal health care, the ability for everyone to see a doctor regardless of income,” he tells Maher.

“So you’re for single-payer?” Maher asks back.

“If that’s how we get there, that’s how we get there,” O’Rourke responds, which Maher notes is “a big if.”

July 14, 2018: A Politico story notes that O’Rourke “no longer uses phrases like ‘single-payer’ or ‘Medicare for all,’” instead replacing those with “universal, guaranteed, high-quality health care for all.”

January 18, 2018: O’Rourke posts a campaign video where he talks a bit more about his vision: “What’s my vision? Universal health care and very likely that will involve some form of a single-payer system. Some expansion of Medicare, perhaps from where it is right now at 65 all the way down to zero. Or I’m open, if somebody has a better way to do this, including especially Republicans, I’m open to their vision of how to get there.” He then goes on to talk about adding Medicare to the marketplace as a public option as “a step we can take on the road to getting to universal health care.”

December 19, 2018: The Associated Press reports, “O’Rourke has endorsed single-payer health care but says he doesn’t support ‘Medicare-for-all’ because expanding the program could adversely affect current recipients.”

I’ve reached out to O’Rourke’s campaign to ask where he currently stands on Medicare-for-all, and will update this story if I get more information. However, he did talk a bit about Medicare-for-all in Iowa Thursday, and seemed to shy away from the label.

Generally, these statements seem to tell the story of him starting as a Medicare-for-all supporter but then slowly backing away from the label, instead talking more about a universal coverage system that might be single-payer or might be something else.

This primary is heavy on policy. So far, O’Rourke isn’t.

This is the fourth election cycle I’ve covered as a journalist and by far the one that is heaviest on policy. Part of that seems to owe to the fact that we have a Democratic primary field dominated by Senators, the type of people who are constantly engaged with creating and pushing new policy ideas.

In the runup to 2020, we’ve seen Democrats rolling out one ambitious policy proposal after another — all attempting to put forward a signature idea that might catch fire with the base (much in the same way Sanders’s Medicare-for-all idea has). Before Cory Booker launched his presidential bid, he rolled out an ambitious plan to give all American kids money from the government in an attempt to reduce the racial wealth gap. Elizabeth Warren preceded her announcement with a plan to have the federal government manufacture generic drugs. Kamala Harris, meanwhile, went with a plan to alleviate poverty that gives billions to low-income Americans.

But O’Rourke doesn’t have a signature policy — he has a signature style. He listens, and he talks a lot about his vision without giving a clear sense of how to get there.

Even on a key policy like Medicare-for-all, one that will no doubt be debated aggressively this primary, he doesn’t really articulate a clear vision for how he would handle that issue. This has its benefits. Medicare-for-all is inherently a legislative idea that would have to go through compromise and negotiation, and flip tough votes. And who knows, maybe he’ll come up with one soon!

But for now, Beto is entering the race without clearly stating his view of what a health care system ought to look like — a view that lots of other candidates are bringing to the table.