Photo Illustration: Sarah Grillo. Photos: David McNew/Getty Images, Drew Angerer/Getty Images, Ethan Miller/Getty Images, and Zach Gibson/Getty Images

The way the Democratic candidates talk about "Medicare for All" has shifted and sharpened over the course of the campaign — and Medicare for All has gotten less popular in the process.

The state of play: When Sen. Bernie Sanders introduced his "Medicare for All" bill in 2017, all of his likely 2020 rivals in the Senate signed on as cosponsors, and many Democrats treated Medicare for All as a catch-all or a loosely defined goal.

What they're saying:

  • Sanders hasn't changed at all. He has tweaked the details of what his plan covers, but still makes the same forceful case for a national plan with no copays, deductibles, premiums or coverage limitations — paid for by tax increases.
  • Sen. Elizabeth Warren still backs Sanders' version of the national health plan, but has said she would pursue a public option first, then a full-scale single-payer program later.
  • Pete Buttigieg has long supported a public option, not Medicare for All, though his criticism of single-payer has gotten more aggressive as he (and Warren) have climbed in the polls.
  • Joe Biden also has a clear position on Medicare for All: He's against it. He, too, prefers a public option. "The party's not there. The party's not there at all," he told "Axios on HBO."

Why it matters: This is the defining debate of the Democratic primary — and it's a fight that Sanders and Biden, at least, are eager to have.

Yes, but: The powerful health care industry, particularly hospitals, opposes a public option almost as fiercely as it opposes single-payer, and would fight it just as hard in Congress, with just as much help from Republicans.

  • Democrats are divided over what to fight for, but it would be a fight no matter what.

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