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Democratic candidates come at Sanders on Medicare for All costs, logistics

From obesity to rural hospitals, debate features surprising healthcare topics.

Seven candidates for the Democratic nomination for president met last night in Charleston, South Carolina for a two-hour debate that was as chaotic as it was passionate, as candidates  struggled to make the most of short speaking time windows to drive home their key talking points, as well as firing off some attacks on their rivals.

Throughout the debate, healthcare-related topics came up quite a bit, and not just around frontrunner Senator Bernie Sanders' Medicare for All proposal. The presidential hopefuls also discussed the current coronavirus crisis and rural access to healthcare, as well as touching on issues around obesity, NIH funding, and the maternal mortality gap between white and black mothers.


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Due to his success in the recent Nevada caucuses, Sanders was expected to be the target of many attacks last night. To the extent that those attacks occurred, they were mostly focused on Medicare for All, which Sanders' opponents attacked as expensive and hard to execute.

"Bernie and I both want to see universal health care, but Bernie's plan doesn't explain how to get there, doesn't show how we're going to get enough allies into it, and doesn't show enough about how we're going to pay for it," Senator Elizabeth Warren said early in the night. "I dug in. I did the work. And then Bernie's team trashed me for it."

Sanders defended the plan by referencing a recent study in The Lancet.

"I'm sure you're familiar with the new study that just came out of Yale University, published in Lancet magazine, one of the prestigious medical journals in the world. You know what it said? Medicare for all will lower health care costs in this country by $450 billion a year and save 68,000 lives of people who otherwise would have died," he said.

The Lancet study in question is good for Sanders, but it notably has been criticized for making some questionable assumptions. 

Amy Klobuchar, another of Sanders' colleagues in the Senate, attacked Sanders on the cost of the program.

"No, the math does not add up," she said. "In fact, just on "60 Minutes" this weekend, he said he wasn't going to rattle through the nickels and the dimes. Well, let me tell you how many nickels and dimes we're talking about: nearly $60 trillion. Do you know how much that is, for all of his programs? That is three times the American economy -- not the federal government -- the entire American economy. The Medicare for All plan alone on page eight clearly says that it will kick 149 million Americans off their current health insurance in four years. That is true. As one prominent Democrat once said, we should pay attention to where the voters of this country are, Bernie. That prominent Democrat was Barack Obama a few months ago. And I think that's what we should do. They are not with you on spending nearly $60 trillion."

Meanwhile, former South Bend Mayor Pete Buttigieg took on Sanders claim that Medicare for All would put the US in  line with "every other country on earth".

"What is a radical idea is completely eliminating all private insurance," Buttigieg said. "And part of how you know it is, is that no industrialized country has gone that far. He and I both like to talk about Denmark, for example. But even in Denmark, they have not abolished the possibility of private insurance. So this is an idea that goes further than what is acceptable in Denmark the country, let alone imagining how that's going to fly in Denmark, South Carolina."


For the Democratic candidates, the coronavirus crisis was mostly an opportunity to levy criticism at the current White House occupant.

"What's really happening here is the president fired the pandemic specialist in this country two years ago," former New York City Mayor Mike Bloomberg said. "So there's nobody here to figure out what the hell we should be doing. And he has defunded the Centers for Disease Control, CDC, so we don't have the organization we need. This is a very serious thing. As you see, the stock market is falling apart because people are really worried and they should be."

In one of the most surreal moments of the debate, Klobuchar used her time on the coronavirus question to directly address the audience, telling them to follow the CDC website and call their healthcare provider if they feel sick.

Former Vice President Joe Biden evoked his executive experience in answering the question of how he would respond to the epidemic.

"What we did with Ebola -- I was part of making sure that pandemic did not get to the United States, saved millions of lives," he replied. "And what we did, we set up, I helped set up that office in the presidency, in the president's office, on -- on diseases that are pandemic diseases.

We increased the budget of the CDC. We increased the NIH budget. We should -- and our president today -- and he's wiped all that out. We did it. We stopped it."


Debate moderator Margaret Brennan asked candidates how they would ensure healthcare is available in rural areas.

Klobuchar was ready with a multi-part response, referencing a bill that would encourage the creation of critical access hospitals, her immigration reform policies that would incentivize doctors from other countries to serve in rural areas, and education reform that will help to address doctor and nurse shortages.

"We're going to have a million openings for home health care workers, particularly in rural areas, that we don't know how to fill," she said. "We're going to have over 100,000 openings for nursing assistants. We're not going to have a shortage of sports marketing degrees. We're going to have a shortage of plumbers and nurses. So putting incentives in place with how we do loan payback, making one- and two-year degrees free, and then of course creating loan payback programs if people will go, especially medical students, into rural areas."

Buttigieg weirdly pivoted on the question to talk about voter suppression and his Frederick Douglass plan.

Sanders leaned on his record to respond, as well as putting in one more plug for his signature issue.

"I'm very proud working with Congressman Jim Clyburn, South Carolina, that we increased funding for the Community Health Center Program by $11 billion as part of the Affordable Care Act, which now provides for 9 million Americans access to primary health care, dental care, mental health counseling, and low-cost prescription drugs, in that bill," he said. "We also put $2 billion into a program which would provide debt forgiveness for doctors, nurses, dentists, we have a major dental affordable crisis in this country, to make sure that they are practicing in underserved areas. The advantage of a Medicare for All healthcare program, because it's not driven by profits for the drug companies and the insurance companies, is we will have health care for all people in all parts of this country."


Early in the debate, in responding to a question about his and Bloombergs' records on race, Buttigieg brought up maternal mortality as an example of something all candidates need to be doing better on.

"I come at this with a great deal of humility, because we have had a lot of issues, especially when it comes to racial justice and policing in my own community," he said. "And I come to this with some humility because I'm conscious of the fact that there are seven white people on this stage talking about racial justice. … None of us had the experience that black women have had that drives that maternal mortality gap that we are all rightly horrified by, of going into a doctor, and being less likely to have your description of being in pain believed because of your race. Since we don't have the experience, the next best thing we can do is actually listen to those who do."


At another point in the debate, Biden proposed increasing investment in the NIH.

"We have a thing in the Defense Department called DARPA, a special operation thing to find out all the things we have to deal to make us safer. They came up with the internet. They came up with the whole idea of stealth technology," he said. "I'm going to do the same thing at the National Institute of Health. We're going to invest at least $50 billion over the first five years focusing on obesity, diabetes, Alzheimer's, and cancer. And we're going to make that investment because no one else is willing to make that investment. We can, in fact, find cures if we make the investment, and we can get that done. The American people support it. Even Republicans will support it. We have to focus on extending life, saving life, and making people -- put them in a position to be able to live longer and more securely."


Finally, Bloomberg was asked specifically about public health and whether he would extend his soda tax initiative for New York City to the whole country as president. 

"Well, I think what's right for New York City isn't necessarily right for all the other cities, otherwise you would have a naked cowboy in every city. So let's get serious here," he said. "But I do think it's the government's job to have good science and to explain to people what science says or how to take care of themselves and extend their lives. We are a country where there are too many people that are obese. We should do something about that. 

"But just a look what happened with smoking.We did ban smoking in New York City in public places, restaurants, offices, and that sort of thing. And it has spread across America, across Europe, across Latin America, even into places in the Middle East and into the Far East. It has saved an enormous number of lives. So it just goes to show, if you have good public health, then you can do things."

Jonah Comstock is editor-in-chief, HIMSSMedia
Twitter: @JonahComstock
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