Illustration: Axios Visuals

Health care has become the framework that defines the broader ideological and stylistic divisions within the Democratic primary — a contest between political revolution and Medicare for All vs. bipartisan compromise and a public option.

Yes, but: It's kind of a false choice. Passing either of those health care plans would require a knock-down, drag-out party-line brawl just as intense as the fight over the Affordable Care Act.

Why it matters: No single issue has highlighted the differences among the Democratic candidates more efficiently — or more often — than health care, and Medicare for All, specifically.

  • It’s more than simple policy differences; in some cases, the policies aren’t even all that different. It has, instead, become a core extension of each candidate’s bigger political identity — whether they wanted it to or not.
  • Bernie Sanders and Joe Biden have already clashed over Medicare for All vs. a public option that Biden brands as "building on Obamacare," and that surely will continue after Biden's strong showing last night.

Ultimately, though, any Democratic president would run into many of the same brick walls trying to get any of these health care plans passed.

  • The health care industry, led by hospitals, has already poured millions of dollars into ads in key primary states opposing not only Medicare for All, but also a public option and even the narrowest proposals to let some people buy into Medicare.
  • Industry managed to kill a public option in the Affordable Care Act, when Democrats had 60 Senate seats. If they have a majority in 2021, it’ll likely be razor-thin.

My thought bubble: Democrats' health care plans have so far mattered a lot as a prism through which the candidates and their supporters have expressed big-picture principles and their theories of change.

  • But these are not the same battle lines that would guide any real effort to significantly expand government-run health insurance.

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Illustration: Sarah Grillo/Axios

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