Democratic Candidates Put Healthcare Front and Center at Debates

Alicia Ault

June 28, 2019

Healthcare was a primary topic over the 2 nights of the first 2020 Democratic presidential candidate debates, with many of the 20 candidates who participated calling for a revamped health system, adoption of Medicare for all, and for new efforts to cut the cost of drugs and to penalize opioid manufacturers.

The candidates — who assembled in Miami, Florida, on June 26 and 27 — also touched on the issues of women's reproductive rights, gun violence, mental health, and the health impact of family separations at the Mexican border.

It's not surprising, as many polls have shown that Democratic voters rank healthcare as a top priority. A Kaiser Family Foundation poll published just ahead of the debates found that 87% of Democratic voters said healthcare was the main topic they wanted to hear candidates discuss, followed by issues affecting women, climate change (73%), gun policy (72%), income inequality (70%), the economy (69%), and immigration (66%).

Voters responding to a USA Today/Suffolk University poll said that healthcare, immigration, the economy, climate change, education, and taxes were important topics.

Rising Dug Costs Attacked

The first question on the first night brought a swipe at the drug industry from Sen. Elizabeth Warren (MA). When moderator and NBC News correspondent Savannah Guthrie asked whether some of Warren's proposals might harm what Guthrie described as a robust economy, Warren responded, "It's doing great for a thinner and thinner slice at the top. It's doing great for giant drug companies. It's just not doing great for people who are trying to get a prescription filled."

Debate, Night 1: L-R, NYC Mayor Bill de Blasio, Congressman Tim Ryan (OH), former HUD Director Julian Castro, Sen. Cory Booker (NJ), Sen. Elizabeth Warren (MA), former Congressman Beto O'Rourke (TX), Sen. Amy Klobuchar (MN), Congresswoman Tulsi Gabbard (HI), Gov. Jay Inslee (WA), former Congressman Jay Delaney (MD).

A few minutes later, Sen. Cory Booker (NJ) said that corporate mergers were harming the nation, adding, "We see that because consumer prices are being raised by pharmaceutical companies that often have monopolistic holds on drugs."

Sen. Amy Klobuchar (MN decried the rising cost of pharmaceuticals, claiming that President Donald J. Trump had done nothing to turn the tide, despite having made a promise to lower prices. She claimed that prices had risen by double digits for some 2500 drugs since Trump took office, and that he "gave $100 billion in giveaways to the pharma companies."

Klobuchar added, "That's what we call at home all foam and no beer." Klobuchar noted that she has proposed to allow Medicare to negotiate drug prices and to allow Americans to import drugs from other nations.

"And pharma thinks they own Washington? Well, they don't own me," she said.

Sen. Bernie Sanders (VT) said that, as president, he would cut drug prices in half.

Medicare for All?

Kaiser's predebate poll found that affordability was a top issue for Democrats and Democratic-leaning independents. Lowering the amount people pay for healthcare was mentioned by the highest percentage (28%), followed by increasing access to care (15%). Another 15% explicitly said they wanted to see a single-payer or Medicare-for-all system like the one introduced by Sanders. But the poll also found that most people don't understand how such a system would work.

Regardless, Sanders' proposal became a central focal point in the debates.

On the second night, Sanders was pressed on whether paying for Medicare for all would mean a significant increase in taxes. He initially did not directly answer, but eventually responded, "People who have healthcare under Medicare for all will have no premiums, no deductibles, no copayments, no out-of-pocket expenses. Yes, they will pay more in taxes, but less in healthcare for what they get."

Debate, Night 2: L-R, Author Marianne Williamson, former Colorado Gov. John Hickenlooper, Tech Entrepreneur Andrew Yang, South Bend, Indiana, Mayor Pete Buttigieg, former Vice President Joe Biden (DE), Sen. Bernie Sanders (VT), Sen. Kamala Harris (CA), Sen. Kirsten Gillibrand (NY), Sen. Michael Bennet (CO), Congressman Eric Swalwell (CA).

A handful of candidates said they supported Sanders' proposal: Warren, Booker, Mayor Bill de Blasio (NYC), and California Sen. Kamala Harris — although the next day she said she'd misunderstood what the moderator had asked and withdrew her support for eradication of private insurance.

Warren was not shy about her backing. "I'm with Bernie on Medicare for all," she said. She said that even with insurance many families go broke paying for medical bills. Families are also "fighting with insurance companies to try to get the healthcare that their doctors say they and their children need," she said, adding, "Medicare for all solves that problem."

Booker said he also supports Medicare for all because it will ensure that healthcare is a right. "We're talking about this as a healthcare issue, but in communities like mine, low-income communities, it's an education issue, because kids who don't have healthcare are not going to succeed in school."

Klobuchar said she supported an incremental approach. "I am just simply concerned about kicking half of America off their health insurance in 4 years, which is exactly what this bill says," she said.

Former Texas congressman Beto O'Rourke had previously espoused getting rid of private insurance — as Medicare for all would do — but has since changed his position. O'Rourke said that under his new proposal uninsured and underinsured individuals would be enrolled in Medicare. "We preserve choice by making sure everybody has care," he said.

De Blasio interjected, wanting to know how O'Rourke could "defend a system that's not working."

Meanwhile, former Maryland congressman John Delaney jumped in and noted that "100 million Americans say they like their private health insurance, by the way."

He added, "We should be the party that keeps what's working and fixes what's broken."

On night 2, former Colorado Governor John Hickenlooper made a similar argument against Medicare for all, saying "you can't expect to eliminate private insurance for 180 million people, many of whom don't want to give it up."

Fellow Coloradan, Sen. Michael Bennet, said he could not support Medicare for all, either, saying the quickest way to get to universal healthcare "is by finishing the work we started with Obamacare and creating a public option so that every family and every person in America can make a choice for their family about whether they want a public option, which for them would be like having Medicare for all, or whether they want to keep their private insurance."

South Bend, Indiana, Mayor Pete Buttigieg is advocating what he calls Medicare for all who want it, citing cost as a huge drawback to Sanders' proposal. "Everybody who says Medicare for all, every person in politics who allows that phrase to escape their lips has a responsibility to explain how you're actually supposed to get from here to there," Buttigieg said.

He would offer a Medicare-like plan on the Affordable Care Act exchanges, saying that if it ends up being more inclusive and efficient, "it will be a very natural glide path to the single-payer environment." Buttigieg also reminded the audience that even countries with so-called socialized medicine have private insurance.

"That's fine. It's just that for our primary care we can't be relying on the tender mercies of the corporate system," he said.

Former Vice President Joe Biden, who has been leading the other candidates by a wide margin in most polls, echoed Buttigieg, saying that the fastest way to get to universal coverage would be to "build on Obamacare, to build on what we did," adding that he proposed that anyone would be able to buy into a Medicare-like plan on the exchange.

Gun Violence

What to do about the proliferation of guns in America — and the accompanying violence — was another area of heated discussion. The topic was especially poignant, given that the debate site in Miami was not far from Marjory Stoneman Douglas High School, where 17 people were killed in a mass shooting in February 2018.

"Seven children will die today from gun violence," said Warren, who said that "Gun violence is a national health emergency in this country. And we need to treat it like that."

She proposed universal background checks, a ban on "weapons of war," and doubling down on research to "find out what really works." Added Warren, "We need to treat this like the virus that's killing our children."

Julian Castro, a Secretary of Housing and Urban Development under President Barack Obama, said he believed that the House, Senate, and presidency would all be Democratic in 2021, and that then it would be possible to achieve "common sense gun reform."

Rep. Tim Ryan (Ohio) called for health-focused solutions, saying, "We need trauma-based care in every school." Ryan claimed that the majority of school shooters choose their own schools to attack, and said it's because most "feel shamed, traumatized, or bullied."

He called for "social and emotional learning," adding, "if our kids are so traumatized that they're getting a gun and going into our schools, we're doing something wrong, too, and we need reform around trauma-based care."

Biden touted his experience in passing gun control legislation, including background checks. And he said he "got assault weapons banned." He said he envisioned initiating gun buybacks and requiring smart guns — which would have technology to prevent anyone but the owner from pulling the trigger. While claiming that he was the only candidate "that has beaten the NRA nationally," Biden a few minutes later said, "Our enemy is the gun manufacturers, not the NRA, the gun manufacturers."

Harris blamed Congress for the lack of action on gun violence. "Congress has not had the courage to act," she said, adding that if legislators had not acted within the first 100 days of her presidency, she would issue an executive order to put into place "the most comprehensive background check policy we've had," and a ban on importation of assault weapons.

As a former prosecutor, "I have seen more autopsy photographs than I care to tell you," Harris said. "I have hugged more mothers who are the mothers of homicide victims." She added, "It is enough. It is enough."

Buttigieg noted that, as a mayor, he too deals with violence. "If more guns made us safer, we would be the safest country on earth," he said. He also blamed Congress. "Common-sense measures like universal background checks can't seem to get delivered by Washington, even when most Republicans, let alone most Americans, agree it's the right thing to do," Buttigieg said.

The combat veteran added, "And as somebody who trained on weapons of war, I can tell you that there are weapons that have absolutely no place in American cities or neighborhoods in peacetime, ever."

Opioids and Mental Health

Several candidates said that they wanted to see criminal prosecution of opioid manufacturers.

"They should absolutely be held criminally liable, because they are liable and responsible," said Booker, who added that the opioid crisis is a factor in why he decided not to take campaign contributions from pharmaceutical companies or executives. Booker also noted that he thought "we've tried to arrest our way out of addiction for too long," but did not have time to offer solutions.

O'Rourke also blamed drug arrests for contributing to the nation's prison population. "Many are there for nonviolent drug crimes, including possession of marijuana, at a time that more than half the states have legalized it or decriminalized it," he said.

He said Purdue Pharma had "been able to act with complete impunity and pay no consequences, not a single night in jail."

O'Rourke added: "We will make sure that they pay a price, and we will help those who've been victims of this malfeasance in this country get them treatment and long-term care."

Fact checkers at The Washington Post noted that Purdue paid a $270 million civil settlement in March to Oklahoma, is the subject of multiple lawsuits, and that, in 2007, three executives pled guilty to misleading federal regulators about addiction risk and received probation.

O'Rourke also noted that, "In Texas, the single largest provider of mental health care services is the county jail system today."

Women's Health

Some candidates were asked about their support for abortion rights and how they would address ongoing efforts in some states to overturn Roe v Wade.

Warren said she "would make certain that every woman has access to the full range of reproductive healthcare services, and that includes birth control, it includes abortion, it includes everything for a woman," and added that she'd codify Roe v Wade under federal law.

Sanders said he believed that "a woman's right to control her own body is a constitutional right. That doesn't mean that a politician should infringe on that right," he said. Sanders also said that he would never appoint a Supreme Court judge who would not agree to uphold Roe v Wade.

Castro took the same tact. Mentioning several states that have passed restrictive abortion laws — Alabama, Georgia, and Missouri — Castro said he "would appoint judges to the federal bench who understand the precedent of Roe v Wade and will respect it."

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube