Presidential Candidates Spar Over Medicare for All in Debates

Alicia Ault

August 01, 2019

The Democratic candidates for president drew battle lines over "Medicare for all" in the second round of debates, which unfolded over 2 nights in Detroit, Michigan, this week.

On both nights, the CNN moderators led off with the question of whether the Medicare for all proposal — championed by Sen. Bernie Sanders (I-VT) and Elizabeth Warren (MA), among other candidates — would be the best way to address the nation's healthcare woes. The ensuing debate consumed almost a half hour each night.

Other health-related topics — such as the cost of pharmaceuticals, gun violence, and women's reproductive rights — received short shrift relative to the time they got in the first round. The opioid crisis was passingly mentioned. Climate change received slightly more attention and was mentioned as a health threat by Washington Governor Jay Inslee.

Candidates assembled on July 30 in Detroit: L-R, Marianne Williamson, Congressman Tim Ryan, Sen. Amy Klobuchar, Mayor Pete Buttigieg, Sen. Bernie Sanders, Sen. Elizabeth Warren, former Congressman Beto, O'Rourke, former Gov. John Hickenlooper, former Congressman John Delaney, Gov. Steve Bullock.

Health topics — and the fate of the Affordable Care Act (ACA) — are of great interest to Democratic voters, according to pollsters. Just ahead of the second debate, the Kaiser Family Foundation's Health Tracking Poll found that support for Medicare for all had dipped, with only 39% of Democrats and Democratic-leaning independents in favor of replacing the ACA with Medicare for all. Fifty-five percent said they wanted to build on the ACA instead. Only 15% of Republicans said they supported Medicare for all.

About half of Democrats in the Kaiser poll said they wanted to hear how the candidates' plans differed from each other. However, Kaiser also found that 42% said they wanted to hear how the plans would differ from President Donald J. Trump's health proposals.

Political Suicide?

On July 30, the first night, moderator Jake Tapper noted that candidate and former Maryland Congressman John Delaney had referred to Medicare for all as "bad policy" and "political suicide," and asked Sanders what he would say to Delaney.

Said Sanders: "You're wrong." He stuck to his guns all night, repeatedly stating that 87 million Americans were uninsured or underinsured and that annually, a half million went bankrupt because of medical bills "while the healthcare industry makes tens of billions of dollars in profit."

Delaney, for his part, espouses a plan that would automatically enroll every American younger than 65 in a new public health plan or let them receive a credit to buy private insurance instead. "We don't have to go around and be the party of subtraction and telling half the country, who has private health insurance, that their health insurance is illegal," said Delaney.

Montana Gov. Steve Bullock also took issue with eliminating private insurance. "At the end of the day, I'm not going to support any plan that rips away quality healthcare from individuals," he said.

Warren jumped into the fray. "We are not about trying to take away healthcare from anyone," she said. "That's what the Republicans are trying to do."

Neither Sanders nor Warren shied away from the proposal, even when pressed on the idea that it would require raising billion in taxes, largely on the middle class. They argued that Americans would be paying more to the government but less to insurance companies. "What I am talking about and others up here are talking about is no deductibles and no copayments," Sanders said.

"Giant corporations and billionaires are going to pay more," said Warren. He added, "Middle-class families are going to pay less out of pocket for their healthcare."

South Bend, Indiana Mayor Pete Buttigieg, who has a similar plan, said that instead of raising taxes, individuals could buy into insurance coverage. "That's the idea of 'Medicare for all who want it,' " he said.

"Look, this is a distinction without a difference, whether you're paying the same money in the form of taxes or premiums," he said. He noted that currently, "If you don't have health coverage, you're paying too much for care, and if you do have health coverage, you're paying too much for care."

The following night, New Jersey Sen. Cory Booker said he supports Medicare for all. Democrats should be the party that creates universal healthcare, he said. "The person that's enjoying this debate most right now is Donald Trump, as we pit Democrats against each other, while he is working right now to take away Americans' healthcare," said Booker. He warned, "There is a court case working through the system that's going to gut the Affordable Care Act and actually gut protections on preexisting conditions."

Businessman Andrew Yang suggested that Medicare for all was the best way to get the American economy moving.

Candidates assembled on July 31 in Detroit: L-R, Sen.Michael Bennet, Sen. Kirsten Gillibrand, former HUD Secretary Julian Castro, Sen. Cory Booker, former Vice President Joe Biden, Sen. Kamala Harris, entrepreneur Andrew Yang, Congresswoman Tulsi Gabbard, Gov. Jay Inslee, Mayor Bill de Blasio.

"As someone who's run a business, I can tell you flat out our current healthcare system makes it harder to hire, it makes it harder to treat people well and give them benefits and treat them as full-time employees. It makes it harder to switch jobs, as Senator Harris just said, and it's certainly a lot harder to start a business," said Yang.

"If we say, look, we're going to get healthcare off the backs of businesses and families, then watch American entrepreneurship recover and bloom," he said.

Harris' Version of Medicare for All

Just ahead of the debate, Sen. Kamala Harris unveiled her health plan, which she is also calling Medicare for all. It differs somewhat from the Sanders/Warren proposal.

Americans would be able to immediately buy into Medicare, and, over the course of 10 years, newborns would be automatically enrolled, as would the uninsured. The long rollout — which differs from the Sanders proposal — gives physicians, hospitals, employers, and others time to transition to the new system, according to Harris. Private insurers would still be able to offer Medicare plans, as long as they stick to the rules of the new system.

"I listened to the American families who said 4 years is just not enough to transition into this new plan, so I devised a plan where it's going to be 10 years of a transition," said Harris at the debate.

"Any time someone tells you you're going to get something good in 10 years, you should wonder why it takes 10 years," retorted former Vice President Joe Biden, who pointed out that the plan would cost $3 trillion over that decade.

Biden also claimed that the plan would require higher taxes on the middle class and that eventually, it would eliminate private insurance. Under the Biden plan, he said, "no one has to keep their private insurance, but they — if they like their insurance, they should be able to keep it."

Public Option?

The former vice president has been a proponent of adding to the ACA. "Obamacare is working," he said. However, more needs to be done, he said: "Take back all the things that Trump took away" and "provide a public option" in which people could purchase Medicare.

Biden claimed his plan would cost $750 billion compared to $30 trillion for Medicare for all.

Minnesota Sen. Amy Klobuchar also backed a public option. "That's what Barack Obama wanted, and it would bring healthcare costs down for everyone," she said. "Clearly, this is the easiest way to move forward quickly, and I want to get things done. People can't wait."

Warren, however, said keeping private insurers would not work. "We have tried this experiment with the insurance companies," she said, "and what they've done is they've sucked billions of dollars out of our healthcare system."

Insurers add bureaucracy and bloat, Warren said. "Why does everybody — why does every doctor, why does every hospital — have to fill out so many complicated forms? It's because it gives insurance companies a chance to say no and to push that cost back on the patients."

Colorado Sen. Michael Bennet said Medicare for all goes too far. "It doesn't make sense for us to take away insurance from half the people in this room and put huge taxes on almost everybody in this room when we pass a public option, trust the American people to make the right decision, and have universal healthcare in this country in 2 years, not 10 years," he said.

Bennet also said that Harris dissembled when she made it seem as if her plan would not eliminate private insurance. "If we can't admit tonight what's in the plan, which is banning employer-based insurance, we're not going to be able to admit that when Donald Trump is accusing Democrats of doing that as well," he said.

Harris would not give ground. "Private insurance companies and private carriers, if they comply by our rules and play by our rules, will be able to offer those employees healthcare coverage under a private Medicare plan or they can have the option of a public Medicare plan," she retorted.

Insulin Costs

The pharmaceutical industry was briefly targeted by the candidates in Detroit. It came in for less demonization than in the first round of debates.

Sanders has for years been clear about his animosity toward drugmakers. "What we are taking on is the fact that over the last 20 years, the drug companies and the insurance companies have spent $4.5 billion of your health insurance money on lobbying and campaign contributions," he said. The senator said he had just come back from a trip to Windsor, Ontario, Canada with dozens of people with diabetes who were on their regular trek to buy lower-priced insulin.

"People paid one tenth the price in Canada for insulin that they're paying in the United States," said Sanders, who has proposed letting Americans import less costly medications from Canada. Booker, Harris, and New York Sen. Kirsten Gillibrand are cosponsors.

Klobuchar also hit on the topic, mentioning constituent Nicole Smith-Holt, whose son Alec died after rationing his insulin. "He died because he didn't have enough money to pay for it," said Klobuchar.

Biden said that under his plan, manufacturers would have to apply for approval of pricing from the Department of Health & Human Services. "You got to come to us and decide what you can sell it for. We will set the price," he said.

In addition, manufacturers would be prohibited from raising the price above the rate of inflation, said Biden.

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