Once again Democratic presidential candidates have taken to the debate stage, this time with the addition of former New York City Mayor Michael Bloomberg, and sparred over healthcare reform.
Healthcare has emerged as a dominant issue among Democratic presidential candidates in the run-up to this year's election.
During Wednesday night's debate in Nevada, each candidate said they supported expanding public healthcare in some form. While Senator Bernie Sanders' Medicare for All plan would be a stem-to-stern overhaul of the current system, Senator Elizabeth Warren's MFA proposal is more gradual, with a slow roll-out that would allow Americans, at least initially, to keep their current insurance.
Mayor Pete Buttigieg, former Vice President Joe Biden and Senator Amy Klobuchar took a more measured approach, saying Americans should be able to keep their private insurance even while the government offers a public option. Buttigieg has called his plan "Medicare for all who want it," while Biden's plan would essentially expand on the existing Affordable Care Act.
Candidates hotly debated the issue. Having slipped in the polls recently, Warren went on the offensive, attacking Buttigieg's plan as "thought up by his consultants." She also attacked Klobuchar's plan for being vague.
Sanders, the emerging front-runner in national polls, has been uncompromising on the issue, but his opponents cited the difficulty he would have in passing it through even a Democratic-controlled Senate.
Prior to the debate, The Culinary Union in Nevada criticized Sanders' plan for taking away the health benefits they negotiated for and replacing them with a government plan, while Sanders sought to assure the union that the benefits they received from a government plan would be even more generous.
Biden, meanwhile, attacked newcomer Bloomberg for his past criticism of the ACA. Bloomberg has surged in national polls largely on the strength of the millions he has spent on television advertisements. He responded to Biden's criticism by saying that he's a fan of the ACA and decried GOP attempts to dismantle the law.
WHY THIS MATTERS: THE COST
While Democrats sparred, a study published in The Lancet began garnering attention for its central finding: that a Medicare for All plan would save the healthcare system about $450 billion annually, translating to savings for the average American family of about $2,400 per year.
The Lancet research argued that other plans would increase costs owing to the lack of savings from overhead, pharmaceutical costs, hospital/clinician fees and fraud detection.
"Medicare for all who want it," authors said, could cost $175 billion more annually than the current system, and $600 billion more than Medicare for All.
At the same time, the healthcare proposal has the potential to prevent about 68,000 deaths per year, the data showed. And that statistic is considered conservative because it doesn't account for underinsured Americans who may forgo care due to unaffordable copays and deductibles.
The annual savings come at a cost, at least initially: According to a working paper published by the Mercatus Center, a Medicare for All bill introduced by Sanders in the Senate in 2017 would increase federal budget commitments by about $32.6 trillion during its first 10 years of full implementation.
The Mercatus Center paper found that even doubling all currently projected individual and corporate income tax collections wouldn't be enough to finance the additional federal costs of the plan. The Sanders campaign has countered that this figure fails to account for the resulting savings in healthcare spending in the U.S. overall.
Authors of The Lancet research advanced a similar contention, saying U.S. healthcare expenditures are higher per capita than in any other country, and that countries tend to control these costs by centralizing them.
THE LARGER TREND
About 24% of the U.S population, or 78 million Americans, lack health insurance, The Lancet found. That includes 37 million Americans who lack insurance altogether.
Republicans have long said they would like to repeal the law and replace it with a market-based plan, but to date, no solid proposals have emerged, and attempts to pick the ACA apart have been largely unsuccessful.
If the ACA were to be repealed, about 21 million Americans could lose coverage, The Lancet found.
Meanwhile, a new POLITICO-Harvard T.H. Chan School of Public Health Survey found that cutting healthcare and prescription drug costs are Americans' top priorities heading into the election season. About 80% said lowering the cost of care is "extremely" or "very" important, including 89% of Democrats and 76% of Republicans.
Earlier this month, The American College of Physicians, which represents internal medicine doctors, broke ranks with its industry peers by endorsing Medicare for All along with an optional government plan.
The stance is a sharp break from most of the healthcare industry, which remains firmly opposed to Medicare for All. Payers are against a plan that would eliminate private insurance. Hospital providers say a government-run health plan would ultimately result in lower reimbursement.