In their previous debates, Democratic presidential candidates spent more time discussing health care than any other topic. But at Wednesday’s debate in Atlanta, health... Democratic debate focuses little on health care, but shows divide

In their previous debates, Democratic presidential candidates spent more time discussing health care than any other topic.

But at Wednesday’s debate in Atlanta, health care was almost crowded off center stage by several other issues.

The 10 Democratic candidates spent much of the two hours addressing topics such as the impeachment inquiry involving President Trump, child care, taxation, housing, foreign policy, race, voting rights, immigration, and climate change.

It was not that health care didn’t draw mentions.

The health care statements reflected the fissure in the party between proponents of Medicare for All, which would cover all Americans through a single government plan, and those who support a government-run health plan that would compete with private insurance, often referred to as a “public option.’’

The debate, which ran slightly more than two hours, took place on a relatively mild November evening at Tyler Perry Studios in southwest Atlanta.

Medicare for All – which would involve the elimination of private insurance – was supported by progressive Sens. Bernie Sanders of Vermont and Elizabeth Warren of Massachusetts.

Health care services are unaffordable for many Americans, Warren said. “I will bring down the cost of prescription drugs,’’ she added. Her Medicare plan, she said, would add benefits such as dental, vision and long-term care.

Sanders said, “The current health care system is not only cruel, it’s dysfunctional.’’ He added the cost of medical care is much more expensive in the U.S. than in other industrialized countries. “Now is the time’’ for dramatic change, Sanders said.

But former Vice President Joe Biden argued that Medicare for All can’t pass Congress. And under that proposal, he said, “you have to give up your private insurance.’’

Mayor Pete Buttigieg of South Bend, Ind., and Minnesota Sen. Amy Klobuchar agreed that the single government-run plan would limit Americans’ choice of health plans. Medicare for All, Buttigieg said, would order people into the program, rather than give them an option of benefit structures.

A hot issue in the party

Polls have consistently shown health care is a leading issue for Americans.

It also has become a top concern in Georgia, which has a high rate of people without health insurance and has some areas with expensive insurance premiums. The state also has a range of public health needs, including addressing high levels of chronic disease.

And recent polling shows Democrats favor action to change the current health care system.

A new poll from Kaiser Family Foundation found that among the overall public, a narrow majority (53%) support the idea of a Medicare-For-All plan. At the same time, two-thirds (65%) say they support a government-run health plan that would compete with private insurance — a public option.

Large majorities of Democrats support both a public option (88%) and Medicare For All (77%).

Most Republicans oppose both approaches to expanding coverage, but more of them favor a public option (41%) than Medicare For All (27%), the Kaiser poll found. Majorities of independents support both options, though a larger share favors a public option.

A political wild card turned up earlier this month, when former President Barack Obama, the most recent Democrat to occupy the White House, urged his party’s presidential contenders to take a more cautious, moderate approach.

“The average American doesn’t think we have to completely tear down the system and remake it. And I think it’s important for us not to lose sight of that,” Obama said to a Washington, D.C., audience, the Associated Press reported.

Medicare is a popular government program, launched in the 1960s, that provides health insurance for Americans 65 and older, and for some people with disabilities.


Conflicting estimates about cost


Warren has estimated Medicare for All would cost $20.5 trillion in additional government spending over 10 years. That is lower than what independent analyses have found, Reuters reported, but Warren has argued that she would achieve savings by lowering administrative costs and reducing drug prices, among other changes. She would rely on tax increases for corporations and the wealthy, and said the plan would not raise taxes for middle-class families “one penny.”

Warren would transition to Medicare for All over a period of three years, starting with legislation to make Medicare available to all Americans while temporarily preserving existing employer-based insurance, Reuters reported.

Sanders’ proposal would cost more than $30 trillion over 10 years, according to independent analyses. He has acknowledged he would impose higher taxes on families to help pay for the program,  but has argued that the typical middle-class family would save overall by eliminating virtually all health expenses, Reuters reported.

Critics of Medicare for All, including some of the Democratic candidates, say it would simply be too costly – and limit choice.

Biden has attacked the progressives’ blueprint, saying that he wants to build on the 2010 Affordable Care Act, Obama’s signature legislation, by adding a public option that preserves the current private insurance system.

The Biden health care plan, estimated to cost $750 billion over 10 years and paid for partly by higher taxes on the wealthy, would let people enroll in a paid government plan, according to Reuters. That plan would be modeled on Medicare and available even to workers with employer-provided policies. The proposal would also expand the ACA’s subsidies for private policies, making them more generous and extending them to more people.

Buttigieg, who coined the phrase “Medicare for all who want it” and repeated it Wednesday night, has argued that a public option will eventually lead to a single-payer system, because individuals will find that Medicare is more cost-efficient than private policies.

A moderate among Democrats, Klobuchar has said she would improve on the Affordable Care Act by adding a public option, giving people the chance to choose a government-backed plan. She has criticized Medicare For All as a “pipe dream.”

Tom Steyer, a billionaire Democratic megadonor who entered the race in July, has said he favors a public option that would allow Americans to choose a government plan.

California Sen. Kamala Harris has released her own Medicare for All plan, which stands somewhere between the sweeping Sanders proposal and more moderate alternatives.

President Lyndon Johnson signs the Medicare bill into law while former President Harry S. Truman looks on.


Under Harris’ proposal, all Americans would be covered by Medicare, but private insurers would continue to play a role by offering plans within the Medicare system similar to the current Medicare Advantage program that allows recipients to choose private insurance plans that offer extra benefits, according to Reuters.

Andrew Yang, an entrepreneur, supports the concept of Medicare for All, arguing that the prevailing job-based insurance system discourages businesses from hiring due to ever-rising costs, while forcing people to stay in jobs they dislike for fear of losing their  coverage. He has said he would not ban private insurers but does not believe they would be able to compete with a  government plan, Reuters reported.

New Jersey Sen. Cory Booker has repeatedly stated his support for Sanders’ Medicare for All bill. But Booker has also said pragmatism may require a more incremental approach, such as a public option, that would eventually lead to a true single-payer system. Like Harris, he has signed on to several alternative Democratic-backed health care bills in the Senate that would create a public option and lower the Medicare eligibility age from 65.

Tulsi Gabbard, a Hawaii congresswoman, has said she supports Medicare For All, and she is a co-sponsor of a version of Sanders’ bill in the U.S. House of Representatives. But Gabbard has also said she would prefer to allow people who are happy with their employer-sponsored health plan to keep it, and she did not raise her hand in June at a debate when the candidates were asked whether they favored eliminating private insurance, Reuters reported.

The last few minutes of Wednesday’s debate centered on abortion, and it was noted that Georgia recently passed anti-abortion legislation.

Klobuchar, Warren, Sanders and Booker each staked out abortion rights positions.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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