ARI SHAPIRO, HOST:
From the time you're born to the time you die, most everybody in the U.S. uses health care. So when Democratic presidential candidates debate how much to change America's health care system, the stakes can feel personal.
UNIDENTIFIED PERSON #1: I'm a little fearful of a government-run system.
UNIDENTIFIED PERSON #2: I'm an entrepreneur, and I'm under 65 years old. So I don't have any health care at all.
UNIDENTIFIED PERSON #3: Some insurances won't cover them. Some insurances will cover half. And you know, the copays are just outstanding.
SHAPIRO: These New Hampshire Democrats are just two months from casting votes in the first primary in the nation. I went there to hear how people's firsthand experience getting sick and being treated shapes their view of this debate.
SHEILA MORRISON: I just put on a fresh pot of coffee.
SHAPIRO: When Sheila Morrison fell into her third diabetic coma, she was in Canada.
MORRISON: The first two comas, alcohol played a big role. The third one, alcohol didn't play a big role. But I still hadn't recognized that I was a Type 1 diabetic and I needed to take care of myself.
SHAPIRO: Canada gives everybody basic coverage under a government-provided system. People have the option of buying more coverage on the private market.
MORRISON: It goes to show, you know, the differences. I mean, the United States has superior health care if you have the right insurance and can get access to it.
SHAPIRO: Sheila Morrison understands these systems well because she's worked for an insurance company, and before that, a hospital, where she handled negotiations between doctors and insurers.
MORRISON: I spent a lot of my time asking these people - I'm like, yeah, you're saying it's not medically necessary. Where did you get your medical degree?
SHAPIRO: After years of negotiating for others, Sheila now has to advocate for her own medical interests. And she's taking it seriously. She's been sober for eight years. She's getting good treatment for depression, and she's committed to monitoring her diabetes. But every time she spends hours trying to negotiate her own medical bills, one thought keeps going through her head.
MORRISON: God help the people that don't have the background that I have.
SHAPIRO: Sheila emerged from her last diabetic coma with some brain damage. So she's now on disability and gets coverage through Medicare. But the program won't cover all the tools that would help her stay healthy. She has an insulin pump, but she says the sensor to tell her when her blood sugar is low isn't covered, so she has to check manually.
MORRISON: I check my sugar with my glucometer here.
SHAPIRO: She's supposed to check her levels eight times a day. Between the care and the fights with insurance...
MORRISON: It's a full-time job (laughter), you know? But I've learned acceptance. There's nothing I can do about it, other than vote, which I do.
SHAPIRO: And when you cast that vote, what do you see it as a vote for? What are you hoping to do with your vote?
MORRISON: Improve my life and the life of people like me.
SHAPIRO: For her, that will not be a vote for a candidate who wants to eliminate private insurance. She's skeptical of giving the government that much power.
MORRISON: People who get insurance through their employer - decent insurance through their employer - if it's working for them and they're paying 20 bucks a week, then go for it.
SHAPIRO: Here's the basic divide among Democratic presidential candidates on health care. Some want to eliminate private insurance and put every American on a program like Medicare. Elizabeth Warren and Bernie Sanders fall into that group.
(SOUNDBITE OF MONTAGE)
ELIZABETH WARREN: We're going to do this by saying everyone is covered by "Medicare for All."
BERNIE SANDERS: Medicare for All - that means no deductibles, no copayments, no out-of-pocket expenses.
SHAPIRO: Others want to expand Medicare without forcing everybody to give up private insurance.
(SOUNDBITE OF MONTAGE)
JOE BIDEN: We should build on Obamacare.
PETE BUTTIGIEG: I propose Medicare for All who want it.
AMY KLOBUCHAR: A public option, a nonprofit choice that would...
SHAPIRO: That group includes Joe Biden, Pete Buttigieg and Amy Klobuchar, among others.
KLOBUCHAR: I also want to thank all of you for being willing to come out in the snow.
SHAPIRO: One sign of how important health care is to the primary - on a wintry day in Milford, N.H., Minnesota Senator Amy Klobuchar showed up at a co-working office and took a handful of questions from voters. Almost half were on health care, even though that isn't the biggest part of her pitch.
Roger Tilton described leaving a Wall Street job to start his own business.
ROGER TILTON: The last three years, I've had no health care at all because it's too expensive.
SHAPIRO: He's 59 and told me he's hoping to stay healthy until he can get on Medicare in six years.
TILTON: If we reduce the age for Medicare from 65 to 55, hey, I'm in. That's cool. I like that.
SHAPIRO: He says it seems like a public option is the bare minimum for the Democratic Party right now, and he's for it. He is lucky not to need care.
Marcella Termini and her family live in Manchester. And for them, going without health care isn't an option.
MARCELLA TERMINI: For the boys - they were diagnosed with autism spectrum disorder at age 2 1/2. So from there, we've had neurology appointments, occupational therapy, speech therapy.
SHAPIRO: Marcella's 11-year-old twins each get different treatments for autism. Her son Vinnie is homeschooled and was excited to have visitors.
VINNIE: I've been collecting Rudolph stuff for, like, two years.
SHAPIRO: Vinnie, you've been collecting Rudolph stuff?
VINNIE: Yeah. See? And I have more in my bag.
SHAPIRO: Nice. And this is the season to finally bring it all out.
VINNIE: Well, no. I keep it out all year.
SHAPIRO: You keep it out all year.
SHAPIRO: But this is the season that it really feels right.
SHAPIRO: Yeah. OK.
Marcella's husband Jason wasn't home because he commutes more than an hour each way to a teaching job in Massachusetts. The family told us Massachusetts mandates that insurance companies cover certain autism therapies, and New Hampshire does not.
TERMINI: He could've got a job in New Hampshire and made, you know, fairly decent money, but we still wouldn't have the insurance coverage.
SHAPIRO: On the one hand, it must feel like a huge inconvenience to have to jump through these hoops. On the other hand, you must feel really lucky that Massachusetts is so nearby.
TERMINI: Yeah. It's been a lifesaver because otherwise, we'd still be in crisis mode trying to figure out, you know, what the kids needed for their services, even just doctor's appointments. It can be really expensive, and we wouldn't be able to cover a mortgage and all of the copays.
SHAPIRO: That personal experience leads her to conclude that private insurance isn't working. And she's ready to get rid of it.
TERMINI: Just knowing the limits that private insurance puts on certain things.
SHAPIRO: What do you say to people who are very encouraging of expanding Medicare to cover everyone who wants it, but also want to hang on to their own private insurance that they're happy with?
TERMINI: I think - this is going to sound awful. I just feel like it's - that's coming from a real place of privilege. It's great that you have great insurance and you can afford it and you like what they cover. But there are whole communities of people who just absolutely cannot afford even the basic health care because of what the insurance costs are.
SHAPIRO: The disagreements in the Democratic primary make it easy to miss that people of both parties actually agree on something big here.
LUCY HODDER: A majority of people in the United States really do want to make sure everybody has insurance coverage.
SHAPIRO: Lucy Hodder is the director of health law and policy at the University of New Hampshire Law School. She says this is a major shift. If Americans generally want everybody to have health care, then the big questions are just about how to provide that care.
HODDER: So we're going to need to decide together. What does health care mean? What do we intend to cover for everybody? What are the choices, and how do we want to make the choices about cost and quality?
SHAPIRO: Do you think this country is up to having that kind of a debate in an honest, fact-based way?
HODDER: It's really hard, and the language we use is really hard.
SHAPIRO: This is a debate the entire country is having. It's just most visible right now among the Democrats running for president. The votes that people in New Hampshire cast two months from now will be a way for some Americans to start making their preferences known.
Later this week, we'll translate some of the complicated jargon in this debate. Single-payer, Medicare for All, public option - we'll explain what it all means.
(SOUNDBITE OF ASO'S "UR OK") Transcript provided by NPR, Copyright NPR.