DETROIT, MICHIGAN - JULY 29: The Fox Theater and surrounding downtown area is prepared for the Democratic Presidential Debate hosted by CNN on July 29, 2019 in Detroit, Michigan. The debate, which will take place on July 30 and 31, will feature the top 20 Democratic candidates. (Photo by Scott Olson/Getty Images)
Tonight, 10 out of 20 Democratic primary contenders will take the stage at the Fox Theatre in Detroit to continue to debate the best path forward for the country on a host of issues -- including healthcare issues.
Senator Bernie Sanders has succeeded in making "Medicare for All", one of his signature platforms, something of a flashpoint for the crowded field, and it's an issue that exemplifies the differences between the far left and moderate left. Many other candidates support a public option, or "Medicare for All Who Want It". A few, like Amy Klobuchar and John Delaney, have their own plans that truly stand out.
A discussion of healthcare coverage is all but assured tonight, but other issues like prescription drug pricing, the opioid crisis, and even maternal mortality, may see some air time.
Read on for a (relatively) quick summary on where each of tonight's debaters stands on major healthcare issues, at least according to their websites and public statements. We'll follow up tomorrow with part 2, in time for the second half of the debates.
Sanders' signature healthcare issue is his Medicare for All plan, a platform that would bring the United States in line with other liberal democracies as a single payer system.
Notably, Sanders' proposal isn't for a national system like the UK's. Healthcare providers like doctors and hospitals would still be private organizations, but they'd be paid by the government, just as they already are for their Medicare and Medicaid populations.
Medicare for All doesn't explicitly eliminate private insurance, but it essentially does: private insurers would be relegated to things like elective and cosmetic surgeries.
Sanders introduced the latest version of the bill in April with 14 cosponsors, including primary opponents Kristen Gillibrand, Cory Booker, and Elizabeth Warren.
Arguments against Medicare for All mostly revolve around how the plan will be paid for (Sanders has suggested several funding options and maintains that the plan would save money in the long run) or around the idea that people who like their current health insurance should be allowed to keep it.
Beyond Medicare For All, Sanders has also been vocal about lowering prescription drug prices, something he has attempted to tackle with the Medicare Drug Price Negotiation Act, which would give Medicare more negotiating power, the Affordable and Safe Prescription Drug Importation Act, which would allow American providers to buy drugs from Canada and other industrialized nations, and the Prescription Drug Price Relief Act, which would peg drug prices to a median of prices in a handful of other nations.
In his words: "The American people are increasingly clear. They want a healthcare system which guarantees health care to all Americans as a right. They want a healthcare system which will lower healthcare costs and save them money. They want a healthcare system which will guarantee them freedom of choice as to which doctor or hospital they can go to. They want a healthcare system which will substantially lower the cost of prescription drugs. They want Medicare for seniors which will finally cover dental care, hearing aids and eyeglasses. In other words, they want Medicare for All, and that's what we will deliver to them."
Despite her reputation for having plans, the Senator from Massachusetts had been quiet on her healthcare plan for some time prior to the first debate, and still lacks a broad healthcare section on her website.
But in the first debate, Warren came onboard with Sanders' plan, confirming her support in subsequent interviews. Whether Warren has any different ideas about the particulars is something that will likely come out tonight. But her reputation for policy clout could help to raise opinions of the Sanders plan if she comes out strongly in support of it.
Even though Warren hasn't been especially upfront about her overall healthcare policy plan, it would be wrong to say she hasn't talked about healthcare. Two of the detailed plans on her website are a plan for combatting the opioid crisis and another for reversing distressing trends in maternal mortality, especially for women of color.
As to the first, she cosponsored the CARE Act with Representative Elijah Cummings. The bill includes $100 billion in federal funding for states and communities -- funded partly by holding executives who helped cause the epidemic accountable. For the latter, Warren has proposed a bundled payment program specifically aimed at lowering maternal mortality.
In her words: "That's the America we deserve. An America where we take care of each other, where health care for every person who needs it matters more than rich families shielding their wealth. An America where when people like the Sacklers destroy millions of lives to make money, they don't get museum wings named after them, they go to jail. Rather than blaming the victims, we need to make sure a crisis like this never happens again. That's why I'll keep fighting for real structural change -- for accountability, and for a real solution for the opioid crisis."
South Bend mayor and breakout candidate Pete Buttigieg has put forward his own version of Medicare for All, called "Medicare for All Who Want It". Essentially, he wants to offer up Medicare for all as a public option, theorizing that the universal availability of optional public healthcare will force private insurers to lower rates and improve coverage.
"This plan makes a Medicare-type public option available on the exchange and invites people to buy into it: if corporate insurers don't lower costs to deliver something dramatically better than what is available today, competition will create the glide path toward Medicare for All," Buttigieg's website states.
Beyond that, the candidate has laid out some healthcare priorities though he hasn't talked too much about how he'll achieve them. These include improving health equity, investing in maternal and infant health, lowering drug prices, making long-term care more affordable, investing resources in mental health, and combatting the opioid and methamphetamine epidemics.
In his words: "This one is very personal for me. I started out this year dealing with the terminal illness of my father. I make decisions for a living, and nothing could have prepared me for the kind of decisions our family faced. But the thing we had going for us was that we never had to make those decisions based on whether it was going to bankrupt our family, because of Medicare. And I want every family to have that same freedom to do what is medically right, not live in financial fear."
Beto O'Rourke, the former Texas State Representative who made an unsuccessful Senate run to unseat Ted Cruz last year, calls his plan "Medicare for America", but it's more like Buttigieg's Medicare for All Who Want It than it is like Medicare for All. In other words, he supports a public option based on Medicare but wants people to be able to continue participating in private, employer-sponsored plans as well.
Like Sanders, he supports lowering drug prices through plans that involve importation from Canada and Europe and improving Medicare's negotiation powers. Like Warren, he has emphasized maternal mortality as a priority. Finally, O'Rourke has placed a strong emphasis on reproductive rights which includes expanding insurance coverage of women's healthcare services.
In his words: "Our plan says that if you're uninsured, we enroll you in Medicare. If you're insufficiently insured, you can't afford your premiums, we enroll you in Medicare. But if you're a member of a union that negotiated for a healthcare plan that you like because it works for you and your family, you're able to keep it."
Minnesota Senator Amy Klobuchar is another candidate whose plan involves a public option, though she has said she's not opposed to single payer as an eventual goal. Klobuchar has looked to Senator Brian Schatz's State Public Option Act as a model. Notably, that bill looks to expand Medicaid rather than Medicare into a public option, placing more responsibility on states (though they would also receive more funding from the federal government).
Klobuchar has published a detailed plan for her first 100 days in office, and it includes a number of healthcare priorities including protecting coverage for people with pre-existing conditions, allowing importation of prescription drugs from Canada and other countries, expanding VA health benefits for women, prioritizing mental health and addiction treatment, improving maternal healthcare, lengthening the ACA open enrollment period, and several others. Expanding VA investment in telehealth even gets a mention.
In her words: "What we need is to expand coverage so people can have a choice for a public option. And that's a start. And you can do it with Medicare. You can do it many ways. But you can also do it with Medicaid, something I don't think we're talking about enough as a potential solution."
Maryland Representative John Delaney has his own healthcare plan called BetterCare, and it's an interesting attempt at a universal healthcare plan that skirts some of the most common objections. The plan does not hinge on expanding Medicare, instead it creates a new plan from which people would transition into Medicare at age 65. It's technically optional, but it's opt-out rather than opt in, allowing people to receive a tax credit to buy their own insurance if they choose. The plan would absorb Medicaid and replace the ACA, both of which will help provide the funding for the program.
Delaney also has a creative solution to prescription drug prices: "a 100% excise tax, levied on the pharmaceutical company on the difference between the average price of a drug sold in the U.S. and the price of that drug in similarly economically developed countries."
In his words: "If you go to every hospital in this country and you ask them one question, which is 'How would it have been for you last year if every one of your bills were paid at the Medicare rate?' every single hospital administrator [would say] they would close. And the Medicare for all bill requires payments to stay at current Medicare rates. So to some extent, we're supporting a bill that will have every hospital closing."
Former Colorado Governor John Hickenlooper is another public option supporter, though he's been somewhat light on details. He has come out against the idea of Medicare for All, and wants people to be able to keep their current private insurance. He believes stronger rules can help control healthcare costs, and universal coverage is essential.
Like several other candidates, Hickenlooper has published plans focused on reproductive health and on the opioid crisis. He's also one of the few to make addressing HIV a part of his platform.
In his words: ""There are so many different ways to cut the pie and work on the issue that we too often are trying to say, 'You're wrong, I'm right,' and this is even within the Democrat Party. It's more important to be unified and say we want universal coverage. We are not going to stop until we get universal coverage."
Like several of the Democratic contenders, Ohio Representative Tim Ryan sees Medicare for All as a long term goal and the public option as a short-term goal. But that's not his main issue in healthcare. On Ryan's website, he totes VA reform -- he wants to expand the VA Whole Health program to reduce veteran suicide -- and also considers agriculture and food reform to be a health issue, as it's linked to healthy eating and the obesity epidemic.
In his words: "We need to think big when it comes to making healthcare more accessible. That's why I have supported the idea of Medicare for All for over a decade. But as we move towards that ultimate goal, we need to be realistic on how we get there. I believe the first step needs to be the creation of a public option. The option will allow Americans to buy into Medicare without getting rid of private health insurance options. We can do this until we can implement Medicare for All in a way that makes sense for the country."
Montana Governor Steve Bullock may be the least progressive candidate on the stage when it comes to healthcare, since he hasn't made a pitch for universal healthcare in any form. He supports repairing and strengthening the Affordable Care Act. Notably, his tenure as Governor did see an expansion of the state's Medicaid program.
In his words: "Health care ought to be affordable, accessibly and of quality. How we get there, there's any number of different paths."
Williamson's positions on healthcare are, in some sense, impressively inclusive: on her website she highlights the roles of the EPA and the FDA in improving our health by improving our food and environment and presents a 15-point plan that includes nutrition education, restricting marketing of sugary foods, cutting farm subsidies, and investigating national stress levels.
"The Consumer Financial Protection Bureau should investigate how hospitals overcharge patients, and the Justice Department antitrust division should explore ways to remove as much of the profit motive out of medicine as we can," she says in one point.
But when it comes to universal healthcare, Williamson's position is actually fairly moderate in comparison to the rest of the field: she wants to add a Medicare-like public option into the Affordable Care Act.
In her words: "I robustly support high-quality universal health coverage for every American. I will do this by making Medicare an option on the Obamacare exchanges. Over time, more people will migrate to Medicare. I also support federal subsidies to ensure medical coverage for every American, even those in states which have refused Medicaid expansion. Those who wish to keep their private insurance may do so."