There have only been a handful of instances where candidates have truly staked out big differences in policy with their other Democratic contenders. Health care has become a dividing line with one end of the spectrum supporting the total elimination of private health insurance, and the other end supporting the creation of a public health insurance option but also seeking to keep a private insurance market as well to avoid maximum disruption.

Former vice president Joe Biden outlined his plan to upgrade ObamaCare by expanding it into offering a public insurance option but also building up private insurance in the process. The gamble, of course, is that Biden is making claims that his plan would allow patients to keep their doctor on an existing plan, a scenario which didn’t pan out when it was promised the first time by President Obama.

CNN reports on the plan, which Biden says is not the equivalent of “Medicare for All”:

Biden’s plan takes the Affordable Care Act as its foundational principle and builds from there. So there is more money to lower the cost of purchasing insurance — and a public option similar to Medicare for those who want it. But there is not much that’s radical in the Biden proposal, nothing coming anywhere close to the “Medicare for All” proposal, which would eliminate the private insurance industry (and the ACA) in favor of a health care system run entirely by the government, supported by at least two of his main rivals for the 2020 Democratic nod.

“We should not be starting from scratch,” Biden said in New Hampshire on Sunday. “We should be building from what we have. There’s no time to wait.” And in a video released Monday morning to accompany his health care proposal, Biden noted that in the first Democratic debate last month he made clear he opposed getting rid of private health insurance.

“I believe we have to protect and build on Obamacare,” Biden said in the video. “I understand the appeal of ‘Medicare for All’ but folks supporting it should be clear that it means getting rid of Obamacare. And I’m not for that.”

It shouldn’t surprise anyone that Biden does not want to scrap a signature piece of legislation championed by his former boss and one which he himself has spent years protecting and defending. To admit that ObamaCare (correctly known as the Affordable Care Act) is flawed and needed to be eliminated would admit that the legislation wasn’t everything it was promised.

Bernie Sanders, on the other hand, sees ObamaCare as a failure because it still allows private health insurance to exist:

Within hours, Vermont Sen. Bernie Sanders, the author the “Medicare for All” legislation, which is supported by Sens. Elizabeth Warren (Mass.) and Kamala Harris (Calif.) among others in the 2020 race, hit back at Biden’s plan. Tweeted Sanders:

“I fought to improve and pass Obamacare. I traveled all over the country to fight the repeal of Obamacare. But I will not be deterred from ending the corporate greed that creates dysfunction in our health care system. We must pass Medicare for All.”

(The Sanders tweet included a video of Barack Obama calling Medicare for All a “good new idea.”)

The end goal here for progressives is to eliminate private insurance altogether, an objective which has been articulated by Sanders, Warren, and Harris alike, among others. However, Harris has waffled over whether she would support the total elimination of private insurance.

Politico offers some greater detail on the specifics of Biden’s plan:

On a call with reporters on Sunday, campaign staff stressed that Biden wouldn’t settle for a watered-down compromise as president and that his plan would help 97 percent of Americans get health coverage. Nearly 5 million Americans in states that haven’t expanded Medicaid would get premium-free access to Biden’s new public option, for instance.

“We’re starting with the Affordable Care Act as the base and going to insist on the elements that we sought last time,” said a senior Biden campaign official. “And we’ll get them this time.”

The Biden administration also would allow all shoppers on the individual insurance market to qualify for premium tax credits, which are currently capped at four times the federal poverty level, or nearly $50,000 for an individual. Undocumented immigrants would be newly allowed to purchase coverage in the ACA marketplaces, although they wouldn’t be eligible for federal subsidies, a campaign official said.

By definition, Biden’s plan looks a lot like what many proponents of ObamaCare wanted it to be from the onset. In the end, the public insurance option from ObamaCare was scrapped due to intense opposition in Congress and a general sentiment against such a move by the American people. Those views, however, since the inception of ObamaCare, have softened somewhat against the creation of some kind of “Medicare for All” public insurance option which Biden now proposes as part of his new health care plan.

Back to the CNN story, which illustrates why this issue is a gamble for Biden, but one which his campaign thinks he can win on:

Biden’s willingness to stand up against the Medicare for All forces is a gamble, yes, but it is a calculated one based on a bevy of polling that seems to suggest the former vice president’s positioning on the issue is the most popular approach.

A recent poll from the Kaiser Family Foundation, which has been tracking views of the ACA for years now, affirms the Biden position. The ACA is viewed favorably by 46% of the country while 40% have an unfavorable view of the law. (Obamacare’s favorable numbers have outpaced its unfavorable ones since almost the minute the former president left office.) Among Democrats, the law is even more popular; 79% view it favorably while just 12% regard it unfavorably.

Taking the small-scale approach has been Biden’s mainstay in the 2020 campaign. He’s for change, but not to the point of Bernie Sanders. As we reported yesterday, Biden believes he can consolidate enough Democratic primary voters to sell a moderate approach on these issues which will better serve him in the general election against President Trump.

Health care will be a big discussion at the second Democratic debate on July 30 and 31. It would be a shame if Biden and Bernie ended up on different nights, but we’ll soon learn the candidate lineup on Thursday of this week.