A dozen candidates, mere moments on health care at fourth Democratic debate

The candidates spent too much time rehashing the same fault lines that have already been well-established in previous debates.

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Photo by Paul Becker

by Arielle Kane, Director of Health Care | Progressive Policy Institute

On Tuesday, the Democratic Presidential candidates squabbled over the nuances of Medicare-for-all, Medicare-for-all who want it, and a public option. As Sen. Kamala Harris pointed it out, it was the fourth debate and the terse exchanges failed to move the conversation beyond basic policy platforms that candidates have already outlined.

The candidates spent too much time rehashing the same fault lines that have already been well-established in previous debates. Kaiser Family Foundation polling released earlier this week showed that the America people, particularly Democrats, want to hear more from candidates on women’s health, surprise medical bills, and out-of-pocket costs. Americans said that candidates had spent too much time discussing Medicare-for-all instead of other health care issues. And Tuesday’s debate continued the pattern of candidates focused on the ideological arguments around Medicare-for-all as an optional or mandatory program.

Sens. Elizabeth Warren and Bernie Sanders support a Medicare-for-all system that gets rid of private insurance. Based on Sen. Sanders’s bill, there would be no cost-sharing with the patient — but there would also be no choice in what type of health coverage a person could get — it would be centralized within the federal government.

Former Vice President Joe Biden and Mayor Pete Buttigieg have outlined proposals that would allow for a Medicare-based public option. While the nuances of their proposals differ, they both support allowing younger Americans to buy-into a Medicare-like public option health plan.

The candidates bickered over whether or not a proposal with a $32 trillion price tag over ten years would require tax increases on the middle class. Spoiler: it would.

But the focus on a proposal that even its supporters admit is “aspirational” misses a valuable opportunity to discuss other health care issues and to demonstrate to the American people that Democrats can disagree with policy specifics while agreeing that all Americans deserve comprehensive, affordable care. They just disagree on the best way to achieve that end.

Many Americans may see Medicare-for-all as out of reach, regardless of how they feel about the proposal. And thus, they want to know how candidates will lower health care costs and protect consumers from the financial ruin that can accompany an adverse health diagnosis. The candidates didn’t discuss outrageous hospital and physician bills and high drug costs that leave people destitute at the more vulnerable times in their lives. If Democrats don’t have 60 votes in the Senate to make health care “free” for everyone, what are the candidates’ proposals to protect consumers?

Additionally, other than a few applause lines, the candidates didn’t take much time to address women’s health and Republican attacks on abortion access. After criticizing the lack of questions on reproductive health, Sen. Harris said that her Justice Department would review laws and if they failed to comply with Roe v. Wade, they wouldn’t go into effect. This led to a discussion around codifying Roe v. Wade which Sens. Cory Booker, Amy Klobuchar, and Former Housing and Urban Development Secretary Julián Castro said they would do.

These mass candidate debates are a frustrating format. With 12 candidates on stage all trying to get a “viral” moment, they aren’t rewarded for explaining important complexities and tradeoffs in health care policy. The format rewards fear-mongering and finger-pointing rather than explaining what feasible policy changes will protect consumers at the most vulnerable times in their lives.

This debate further demonstrated how American voters would be better served with debates focused on a singular issue — like health care. This would allow candidates to get into the weeds on policy and move beyond grandiose value statements. While it is vital to understand the candidates’ values, the current format doesn’t allow for any discussion beyond that. Health care is likely to be a central issue of the 2020 campaign and voters deserve a more nuanced understanding of the issues at stake.

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