During the first night of the Democratic primary debates, health care was the first major issue up for deliberation, but with little-to-no proposals laid out for the American people. Instead, there were simply vague references to everything from pharma pricing to Medicare For All (MFA). In fact, Sen. Elizabeth Warren refused to even comment on whether she supports limits on abortions. And Cory Booker got tongue-tied asserting that health care “is not just a human right, it’s an American right.”
While there are currently many flavors of Democrats participating in the first presidential debate—and even more in the 2020 presidential race—and diversity in universal health care “plans,” no one plan seems to be getting much traction within the party.
For example, as Ezekiel Emanuel—the oncologist, bioethicist, advisor to President Obama on the Affordable Care Act, and brother of Rahm Emanuel—pointed out just hours before the debate at an event in DC, Americans like Medicare For All in theory, but not in practice. This makes the “debate” around MFA a waste of time for everyone on stage.
He also asserted that at present, “Wrangling all the Democrats is a challenge,” and wished those running on the Democratic ticket would spend their time more fruitfully than on proposals like Medicare For All.
That didn’t stop a MFA question from quickly dividing the field into those who would eliminate private health insurance and those who would not do so immediately. Warren affirmed that she supported Sen. Bernie Sander’s MFA bill (that she co-sponsored along with Cory Booker, Kirsten Gillibrand, Kamala Harris, and others), as did New York City Mayor Bill de Blasio. It would create a single-payer, government-run Medicare system across the U.S. with no private option.
This is in contrast to Beto O’Rourke (among others, such as Amy Klobuchar and Tulsi Gabbard) who stated that he “would not replace private insurance.” Under those versions, there would still be universal coverage, but piecemealed across variations of employer-provided insurance, privately purchased insurance, and government-funded insurance.
But the best line of the night was delivered by John Delaney, who directly confronted his peers who want to do away with private insurance by asserting, “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 said they would close. And the Medicare For All bill requires payments to stay at current Medicare rates. So, to some extent we’re basically supporting a bill that will have every hospital closed.”
This brought about a discussion on insurance companies and their role in the broader system. Unfortunately, it was not an honest assessment of the ongoing and future role of health insurance in America.
According to Warren, insurance companies are a “giant industry that wants the system to stay the way it is.” On that part, she’s 100 percent correct. But she failed to follow through with any plan to change that, as did everyone on stage. They know insurance in the U.S. is a trillion-dollar industry. Like it or not, an industry that big can’t be put out of business easily.
There was also a glaring omission of the universal coverage discussion: auto-enrollment, which must be addressed to get the uninsured insured, even if that entails enrolling people the moment they touch the care system. Gabbard came the closest to addressing coverage concerns when she touched on universal coverage. But she asserted it would be a cost-savings to Americans. She claimed it “will reduce administrative costs and bureaucratic costs.”
But it didn’t appear that anyone else on stage or in the audience was buying it. So deeper conversation was avoided.
The same avoidance of substantive discussion went for pharmaceutical companies as well. The Democratic candidates were quick to attack pharma pricing. But again, there were no major announcements or plans for change. Instead, there was finger pointing.
Klobuchar blamed President Trump for failing to follow through on his commitments to lower drug prices (although she didn’t propose a solution of her own). Or, as she put it, his attempts to lower drug prices were, “all foam and no beer.”
Despite dedicated time for all 10 Democratic candidates to lay out a plan or set themselves apart in the 2020 presidential health debate, nothing of substance came from the first night of debate.
We can only hope that on the second night candidates might begin to address deeper and more specific problems and solutions, such as coverage for children, cost reduction for the elderly and those responsible for parents in long-term care, mental health reform, or medical school loan payoffs to address the doctor shortages across the country.
Based on the first night of debates, I won’t get my hopes up. Like Emanuel, however, I’ll keep wishing that the Democrats running for president spend their time more fruitfully than on proposals like Medicare For All.