Medicare for All Makes Room for Abortion, Opioids in Dem Debate

Alicia Ault

October 16, 2019

For the first time, healthcare was not the initial or the biggest topic during a Democratic debate, although it did get a fair amount of air time during the most recent face-off among those seeking the 2020 presidential nomination ― with Medicare for all sharing the spotlight with abortion, personal health, and the fallout from the opioid epidemic.

Twelve candidates shared the stage at Otterbein University near Columbus, Ohio, last night. Owing to the number of candidates, moderators did not allow opening statements and aggressively limited answers and responses.

Not surprisingly, moderator Anderson Cooper of CNN led off the debate with questions about the impeachment inquiry underway against President Donald J. Trump.

Who Pays for Medicare for All?

About 20 minutes in, moderator Marc Lacey of the New York Times asked Senator Elizabeth Warren (MA) the question that's been asked of her in every debate: whether she would raise taxes to pay for the Medicare-for-all plan that she and Senator Bernie Sanders (VT) have championed.

"I have made clear what my principles are here: Costs will go up for the wealthy and for corporations, and for hardworking middle-class families, costs will go down," Warren said, adding, "I will not sign a bill into law that does not lower costs for middle-class families."

Other candidates pounced on her nonanswer.

"A yes-or-no question that didn't get a yes-or-no answer," said South Bend, Indiana Mayor Pete Buttigieg, who touted his "Medicare-for-all-who-want-it" plan that he unveiled in September.

Warren counterattacked, calling his proposal, which allows people to buy into a public health plan, "Medicare for all who can afford it." She called Medicare for all "the gold standard" because "it is the way we get healthcare coverage for every single American."

Sanders, for his part, said, "I do think it is appropriate to acknowledge that taxes will go up," especially for the wealthy. He contended that the tax increase would be less than what people have been paying for premiums and out-of-pocket costs.

"At least Bernie is being honest here," said Senator Amy Klobuchar (MN). "And I'm sorry, Elizabeth, but you have not said that, and I think we owe the American people to tell them where we will send the invoice," she said, inferring that Medicare for all is not a viable plan but instead a "pipe dream."

Voters Want Broader Health Discussion

Klobuchar complained about the lack of a broad discussion on healthcare during the debates — something that Democratic voters apparently agree with.

In a just-released Kaiser Family Foundation (KFF) tracking poll, 58% of Democrats or those leaning Democrat said the candidates had spent too little time discussing women's healthcare. About half in the poll said candidates had not talked enough about surprise medical bills, lowering the cost of healthcare, or reducing the cost of prescription drugs.

In addition, the number of Americans who support Medicare for all has been declining. Fifty-one percent of the voting public are in favor now, down 5% since April; 47% oppose such a plan, according to the KFF poll. Almost three quarters of all Americans said they were in favor of a government-run "public option" that would compete with private health insurers.

Former Vice President Joe Biden was the first to support a public option, which is a key aspect of his health plan.

Codify Roe v Wade

As discussion about Medicare for all continued, Senator Kamala Harris (CA) interjected that it was time to move on to women's healthcare.

"This is the sixth debate we have had in this presidential cycle and not nearly one word, with all of these discussions about healthcare, on women's access to reproductive healthcare, which is under full-on attack in America today," said Harris.

"It is not an exaggeration to say women will die, poor women, women of color will die, because these Republican legislators in these various states who are out of touch with America are telling women what to do with our bodies," she said.

Senator Cory Booker (NJ) agreed, saying that there is a "clear and existential threat in America" to women's reproductive rights.

Moderator Erin Burnett of CNN later asked how candidates would protect women's access to abortion and reproductive care. Harris said she'd make Roe v Wade the law of the land and that she'd order the Department of Justice to review state laws to prevent those not aligned with the law from going into effect.

Booker said he would create an office of reproductive freedom in the White House to "begin to fight back."

Biden also said he'd codify Roe v Wade and added that he would back Supreme Court nominees who support the right of privacy, "on which the entire notion of a women's right to choose is based."

Jail for Opioid Makers

The opioid epidemic came up, in part, because Ohio has been one of the hardest hit states. Several candidates suggested, as they have before, that opioid manufacturers' executives should be held criminally responsible for addiction and deaths.

"They are nothing more than some high-level dope dealers," said Harris.

"They knew what they were pushing in communities and states like Ohio, without any concern about the repercussions, because they were profiting and making big bucks," she said, adding that "they should be held accountable. This is a matter of justice."

"We need to take on those pharma companies and make them pay for the addictions that they have caused and the people that they have killed," said Klobuchar, adding that "the people that should pay for this, that should pay for the treatment, are the very people that got people hooked and killed them in the first place. And that is the people that are manufacturing these opioids."

Former Congressman Beto O'Rourke (TX) agreed, saying, "Until we hold those responsible accountable for their actions ― Purdue Pharma, Johnson & Johnson ― we're going to continue to have this problem going on again."

Businessman Andrew Yang said he would decriminalize opiates for personal use, open "safe consumption and safe injection sites," and let people who need treatment "know that they're not going to be referred to a prison cell."

Does Age Matter?

Given that the 78-year-old Sanders had a heart attack 2 weeks before the debate, it was not surprising that he was asked about his physical fitness.

"I'm healthy, I'm feeling great," he said. He emphasized that he would reassure doubters by "mounting a vigorous campaign all over this country."

Burnett turned to Biden and, noting that he would turn 80 during his first term, asked if he would be able to execute his presidential duties. Biden, 76, touted his wisdom and experience. "I will not need any on-the-job training the day I take office," he said.

Biden also promised to release his medical records before the Iowa primary "so that you can have full transparency as to my health and what I am doing," he said.

Warren, who is 70, was also asked about her fitness. "I will outwork, out-organize, and outlast anyone, and that includes Donald Trump, Mike Pence, or whoever the Republicans get stuck with," she said.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: