Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.


October 16, 2019

Democratic candidates again debate 'Medicare for All,' but is that what voters want to hear?

Daily Briefing

    Candidates seeking the 2020 Democratic nomination for president during Tuesday's primary debate touched on several health care topics, including abortion, the U.S. opioid epidemic, and so-called "Medicare-for-All" proposals.

    Where the 2020 Democratic candidates stand on health care

    However, some recent research suggests the candidates might not have discussed the health care issues voters most wanted to hear about.

    Debate details

    The debate was hosted by CNN and the New York Times and took place in Ohio. It featured the leading 12 candidates seeking the Democratic nomination for president:

    • Former Vice President Joe Biden;
    • Sen. Cory Booker (D-N.J.);
    • South Bend, Indiana, Mayor Pete Buttigieg (D);
    • Former Department of Housing and Urban Development Secretary Julian Castro;
    • Rep. Tulsi Gabbard (D-Hawaii);
    • Sen. Kamala Harris (D-Calif.);
    • Sen. Amy Klobuchar (D-Minn.);
    • Former Rep. Beto O'Rourke (D-Texas);
    • Sen. Bernie Sanders (I-Vt.);
    • Tom Steyer, billionaire and environmentalist;
    • Sen. Elizabeth Warren (D-Mass.); and
    • Andrew Yang, an author and entrepreneur.

    Candidates touch on health care topics

    The candidates weighed in on several health care topics during the debate, which highlighted where they differ on some key issues.

    Abortion rights

    For instance, according to Axios, the candidates were "divided on packing a court to protect" the Supreme Court's Roe v. Wade decision, which guaranteed U.S. women's right to abortion care, and on how to stop states from enacting laws that restrict abortion care.

    Buttigieg suggested a Democratic president should look to add judges to the Supreme Court that would uphold the Roe decision as a way to ensure it is not overturned.

    However, Biden said he "would not get into court packing." Instead, he said, "I would make sure we move and insist that we pass, we codify Roe v. Wade."

    Gabbard similarly said federal lawmakers should work to codify the Roe decision. However, Gabbard also said lawmakers should ensure that abortions are not permitted during the third trimester of pregnancy "unless the life or severe health consequences of a woman are at risk."

    Castro recommended that, instead of packing the Supreme Court, "The smarter move might be to look at term limits or having people cycle off from the appellate courts so that you would have a replenishment of perspective."

    Harris raised concerns that organizers of the primary debates thus far have dedicated little time to discussing reproductive and abortion rights. "People need to keep their hands off of women's bodies and let women make the decisions about their own lives," she said.

    Harris also said, if elected, she would direct the Department of Justice to review state laws concerning abortion requirements before they take effect to ensure they are legal.

    Booker applauded Harris' comments and added, "Women should not be the only ones taking up this cause and this fight. It is not just because women are our voters and our friends and our wives. It's because women are people and people deserve to control their own body."

    Medicare for All

    The candidates also discussed their proposals to expand health coverage in the United States, and some of the candidates raised concerns about how much Medicare-for-All proposals would cost to implement. Medicare-for-All's costs, and how to pay for them, has emerged as a sticking point in the Democratic primary debates.

    During the debate, moderator Marc Lacey asked Warren for a "yes" or "no" answer on whether the senator's Medicare-for-All proposal would result in higher taxes for middle-income U.S. residents. But, according to the Los Angeles Times, Warren "did not answer directly, instead saying that she would not sign legislation that increased costs for the middle class." Warren said, "I have made clear what my principles are here, which is costs will go up for the wealthy and big corporations, and for hard-working middle-class families, costs will go down."

    Buttigieg criticized Warren for not releasing details on how she would pay for her proposal's coverage expansions. "No plan has been laid out to explain how a multi-trillion-dollar hole in this Medicare-for-All plan that … Warren is putting forward is expected to get filled in," he said.

    Klobuchar also said Warren should release more details about how her plan would be funded. "We owe it to the American people to tell them where we're going to send the invoice," Klobuchar said.

    Biden also criticized Warren's health reform plan as "vague."

    Sanders said his Medicare-for-All proposal would raise taxes for many Americans, but he added that Americans' overall costs would decrease because they no longer would have to pay health insurance deductibles, premiums, and other out-of-pocket costs.

    Buttigieg also pushed back against Medicare-for-All proposals, such as Sanders', that would largely eliminate private health coverage. Buttigieg's "Medicare for All Who Want It" plan would create a public health plan in which Americans could choose to enroll.

    "I don't understand why you believe the only way to deliver coverage for everybody is to obliterate private plans," Buttigieg said during the debate, adding, "I don't think the American people are wrong when they say what they want is a choice."

    But Warren said Buttigieg's plan would not ensure all U.S. residents could access health coverage. "Whenever someone hears the term 'Medicare for All Who Want It,' understand what that really means is Medicare for All Who Can Afford It," she said.

    Opioid epidemic

    The candidates also discussed proposals to address the U.S. opioid epidemic, with many expressing support for targeting pharmaceutical companies that contributed to the crisis—including jailing pharmaceutical executives in certain cases, which Sanders proposed in a bill he introduced last year.

    Harris said, "I do think of this as a matter of justice and accountability because they are nothing more than some high-level dope dealers." She continued, "Let's end mass incarceration and end that failed war on drugs, and let's go after these pharmaceutical companies for what they've been doing to destroy our country and states like Ohio."

    Castro said pharmaceutical executives "need to be held accountable not only financially but also with criminal penalties."

    Yang said, "We have to recognize this is a disease of capitalism run amuck. There was a point when there were more opioid prescriptions in the state of Ohio than human beings in the state of Ohio."

    President's age

    The candidates also weighed in on their thoughts about aging and the presidency, prompted by reports earlier this month that Sanders had undergone treatment for a heart attack, which sparked questions from observers about Sanders' physical wellness going forward. Sanders, age 78, is the oldest candidate seeking the 2020 Democratic nomination for president, and is five years older than President Trump, who is the oldest person to have been elected as a first-term president. According to Axios, Biden is 76 years old, and Warren is 70. Biden, Sanders, and Warren currently are the top three candidates seeking the Democratic nomination for president.

    Biden said, "I know what the job is. I've been engaged. Look, one of the reasons I'm running is because of my age and my experience."

    Sanders said, "We are going to be mounting a vigorous campaign all over this country. That is how I think I can reassure the American people."

    Warren said, "I will outwork, out-organize, and outlast anyone, and that includes … Trump, [Vice President] Mike Pence, or whoever the Republicans get stuck with."

    Research shows voters want to hear candidates' plans for lowering health care costs

    While the candidates briefly touched on access to abortion and once again debated health care costs in relation to Medicare-for-All proposals, they did not discuss plans to lower health care costs that are not tied to coverage expansions, despite recent research showing U.S. voters want to hear less about Medicare for All and more about health care issues.

    According to the Washington Post's "PowerPost," a Kaiser Family Foundation poll released Monday found most voters think presidential candidates have spent enough, or too much, time talking about Medicare for All, and not enough time talking about health care costs more broadly, prescription drug costs, reproductive health, and so-called "surprise" medical bills.

    A Morning Consult poll published last month also found that many voters want to hear about candidates plans' to address individual health care costs, such as copayments and deductibles for private health plans, and prescription drug costs (Fernandez, Axios, 10/15; Mehta, Los Angeles Times, 10/15; Breuninger, CNBC, 10/15; Burns/Martin, New York Times, 10/15; Hunnicutt/Renshaw, Reuters, 10/15; Lopez, Vox, 10/15; Finnegan, Los Angeles Times, 10/15; Winfield Cunningham, "PowerPost," Washington Post, 10/15; Owens, "Vitals," Axios, 9/19).

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.