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The field of 2020 presidential candidates with health care overhaul plans is crowded, and Pete Buttigieg, mayor of South Bend, Ind., is drawing lines of distinction between his proposal and his competitors' plans.

"I mean, the reality is, all these beautiful proposals we all put forward, their impact is kind of multiplied by zero if you can't actually get it through Congress, and it's one of the reasons why I do favor the approach that I have," he said.

Buttigieg would offer public health insurance to those who want it while also keeping private health care plans available. Other candidates' proposals, including "Medicare for All" — backed by Sens. Bernie Sanders and Elizabeth Warren — would replace the current system with a single-payer, government-run program and eliminate private insurance altogether.

Buttigieg spoke to two undecided Indiana voters and NPR host Scott Simon as part of the Off Script series of interviews with 2020 presidential candidates.

"We make sure that everybody can afford [public health insurance], but we don't require you to take it. And partly I think that's just the right policy, because I think people should be able to choose," he said. "But it's also really important that that's a policy that commands the support of most Americans. ... We have a moment where we can get something that big done and most Americans want it done. That's not true of some of the other ideas out there, which would make it much harder to actually achieve them no matter how good they sound in campaign season."

The voters — Michael Logan, a 54-year-old retired Michigan State Police detective sergeant, and Jacque Stahl, 37, who works with a health care group in South Bend — pressed Buttigieg on his plan.

Stahl's 5-year-old son has a condition that requires treatment that if uninsured would cost her family $35,000 a month. She said the health care system can be confusing even for those in the industry, and Americans who do their best to stay in-network can be faced with large surprise medical bills.

Buttigieg told her he's proposing to end surprise billing.

"We would set 200% of Medicare, would be the highest that even an out-of-network therapy could cost when you have a hospitalization or something like that," he said. "Because some of this is also the responsibility of hospitals and health care providers. This can't just be handled on the insurance side."

Buttigieg is polling second in Iowa according to a Quinnipiac University poll released Wednesday. The poll shows Buttigieg polling at 19%, trailing Warren, who is receiving 20%. Iowa holds the first-in-the-nation caucuses on Feb. 3.

Off Script is edited and produced for broadcast by Ashley Brown and Bridget De Chagas. Eric Marrapodi is Off Script's supervising editor.

Copyright NPR 2020.