December 20, 2019

Candidates seeking the 2020 Democratic nomination for president during Thursday's primary debate again clashed over so-called "Medicare-for-All" proposals—closing out the final debate of this year with a topic that has dominated the Democratic presidential primary debates so far.

Debate details

The debate featured seven candidates seeking the Democratic nomination for president:

  • Former Vice President Joe Biden;
  • South Bend, Indian, Mayor Pete Buttigieg (D);
  • Sen. Amy Klobuchar (D-Minn.);
  • Sen. Bernie Sanders (I-Vt.);
  • Billionaire Tom Steyer;
  • Sen. Elizabeth Warren (D-Mass.); and
  • Entrepreneur Andrew Yang.

Thursday's debate was the sixth and final Democratic presidential primary debate scheduled to occur this year. According to Kaiser Health News, a seventh debate is scheduled for Jan. 14, 2020, three more are scheduled for February 2020, and another two are planned—though dates for those debates have not yet been announced.

Is a single-payer health system 'realistic'?

While discussions on health care did not dominate Thursday's debate to the same extent it has in past debates this year, candidates toward the end the evening addressed whether shifting the United States to a single-payer health system under some candidates' Medicare-for-All proposals is practical in today's political climate.

Debate moderators asked Biden about the likelihood that policymakers could implement a single-payer health system, noting the challenges former President Barack Obama's administration had getting Congress to enact the Affordable Care Act (ACA) 10 years ago.

Biden responded, "I don't think it is realistic."

Biden raised concerns about the tax burden of shifting to a single-payer health system, noting that U.S. residents already pay taxes to fund the comparatively smaller share of people that currently are covered by Medicare. He said implementing a Medicare-for-All plan would cost an estimated $20 trillion to $30 trillion over 10 years.

Biden also noted that Medicare-for-All proposals largely would eliminate private health plans, meaning many U.S. residents would lose their existing coverage. Instead, he touted his so-called "public option" proposal, which would create a government-run health plan to compete with private insurance. "You shouldn't have Washington dictating to you that you cannot keep the plan you have," he said.

Similarly, Klobuchar touched on the difficulty of implementing a single-payer system that would remove U.S. residents from their current health plans. "If you want to cross a river over some troubled waters, you build a bridge. You don't blow one up."

Further, Klobuchar said it is unlikely such a proposal would pass Congress given that there are moderate Democratic lawmakers, in addition to Republican lawmakers, who do not support Medicare for All.

However, Sanders noted that while U.S. residents' taxes would increase under his Medicare-for-All proposal, his plan would eliminate deductible, premium, and out-of-pocket costs for health coverage and place an annual cap on how much U.S. residents pay out of pocket for prescription drugs.

In addition, Sanders said there is a need for overhauling the U.S. health system, which he argued focuses more on profits than on caring for U.S. residents. "The day has got to come, and I will bring that day about, when we finally say to the drug companies and the insurance companies, the function of health care is to provide it for all people in an effective way. Not to make profits for the drug companies and the insurance companies," Sanders said.

But Sanders avoided answering a question regarding how he would implement his Medicare-for-All plan if Republicans control the Senate, meaning his plan likely would not get Congress' approval, by "insisting that he could build pressure for Medicare for All by appealing to the public," The Hill reports.

Candidates touch on other health care issues

Candidates during the debate also touched on other health care issues, including care for individuals with disabilities, racial disparities in U.S. maternal mortality rates, and public health.

Yang, who has a child with special needs, touted his proposals to expand care for individuals with disabilities. "We're going to take this burden off of the communities and off of the schools who do not have the resources to support kids like my son, and make it a federal priority, not a local one, so they're not robbing Peter to pay Paul," Yang said.

Warren said she would fully fund the Individuals with Disabilities Education Act, which is intended to provide no-cost, specialized education to individuals with disabilities, KHN reports. Warren also said she would support efforts to connect individuals with disabilities with housing and employment. "You've got to go at it at every part of what we do. Because as a nation, this is truly a measure of who we are," she said.

However, candidates during the debate did not mention an appeals court ruling issued Wednesday that struck down the ACA's individual mandate and kicked questions regarding the entire law's constitutionality back to a lower court, The Hill reports. According to Axios' "Vitals," some top strategists criticized the candidates' for failing to talk about the ruling.

Andy Slavitt, who served as CMS' acting director under Obama's administration, in a tweet posted Thursday wrote, "Democratic presidential candidates: mention that [President] Trump is a step closer to repealing the ACA and is a grave danger to millions. Just once" (Huetteman, Kaiser Health News, 12/20; Washington Post, 12/19; Sullivan, The Hill, 12/19; Halper, Los Angeles Times, 12/19; Owens, "Vitals," Axios, 12/20; Slavitt tweet, 12/19).

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