The Detroit Debate Quickly Turned Into A Big Scrum Over Health Care

DETROIT If you want to know what an argument about “Medicare for All” would look like in a general election, the Democratic primary debate on Tuesday gave you a pretty good preview.

For roughly 30 minutes, the candidates argued with each other and, sometimes, with CNN moderator Jake Tapper over the merits of creating a new, government-run insurance program that would enroll every American.

Defenders of the idea had passion and truth on their side. They faced some patently disingenuous attacks and had accurate, powerful responses to them.

But they never got around to addressing some of the more legitimate qualms Medicare for All skeptics have raised and at some point, presumably, they’ll need to do so.

The Misleading Attacks On Medicare For All

The case for Medicare for All came primarily from the two candidates who, among the 10 candidates assembled in Detroit on Tuesday night, are currently leading in the polls: Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.).

Each championed the idea in his or her distinctive way: Sanders attacked the drug and insurance industries for their massive profits, and Warren talked about a progressive activist, Ady Barkan, who is dying from ALS and struggling to pay his medical bills. 

Although the two lawmakers are potential rivals and presumably fighting over some of the same voters, they stood shoulder to shoulder on health care (literally as well as figuratively, since they were next to each another on stage).

“Health care is a human right, not a privilege,” Sanders said. “I believe that. I will fight for that.”

On the other side of the debate was a group of candidates well behind in the polls, including a current red-state governor (Steve Bullock of Montana), a former swing state governor (John Hickenlooper of Colorado), a swing state senator (Amy Klobuchar of Minnesota), and a former blue-state congressman (John Delaney of Maryland).

These candidates launched some incendiary, but misleading, attacks. 

Bullock at one point likened Medicare for All to Republican assaults on the Affordable Care Act, even though the goal of both programs is universal health care. “It used to be just Republicans who wanted to repeal and replace,” he said. 

Delaney, for his part, acted as if Medicare for All would take away health care from people. “We don’t have to go around and be the party of subtraction, and telling half the country, who has private health insurance, that their health insurance is illegal,” he said. 

Those attacks prompted a sharp response from Warren, who accused her fellow Democrats of adopting and reinforcing Republican talking points. It was a dig at her rivals on stage and, perhaps, one who was not: former Vice President Joe Biden, who has made similar arguments against Medicare for All.

“Let’s be clear about this,” Warren said. “We are the Democrats. We are not trying to take health care away from anyone. That’s what Republicans are trying to do.”

And Sanders noted that benefits under his Medicare for All bill  would be more generous than what even the most comprehensive private-sector plans offer today. When Rep. Tim Ryan (D-Ohio) suggested Sanders didn’t understand the proposal, the Vermont senator shot back: “I wrote the damn bill.”

Sanders also challenged Tapper, who kept asking candidates whether they supported the tax increases that Medicare for All would require for financing.

Tapper was careful to note that the taxes would replace existing premiums people pay, but Sanders said the framing shifted focus away from the real issue: whether poor and middle-class people would have to pay more or less for their health care. 

“Jake, your question is a Republican talking point,” Sanders said.

On this point, Sanders and Warren got reinforcement from Pete Buttigieg, the mayor of South Bend, Indiana. Buttigieg has said he prefers to make enrollment in a new government plan optional, not mandatory. But he noted that the argument about whether people pay more in taxes or premiums is a “distinction without a difference.” 

The Not-So-Misleading Attacks On Medicare For All

But not every argument against Medicare for All was so disingenuous.

Late in the exchange, Delaney warned that Medicare for All would mean worse health care. He argued that Sanders’ proposal would pay hospitals less, which would force many to downsize or close. 

The effect of Medicare for All on providers of health care is a real issue, experts agree, because the plans all assume significant reductions in payments to providers. Delaney overstated the case, and most experts say providers could adjust as long as the cuts are not too large or too quick. 

But neither Sanders nor Warren even acknowledged the possibility that Medicare for All could affect providers adversely. Instead, they kept returning to the profits of drugmakers and insurance companies, as if that were the entire problem. 

“The basic profit model of an insurance company is taking as much money as you can in premiums and pay out as little as possible in health care coverage,” Warren said. “Medicare for All will fix that.”

And while Sanders and Warren correctly pointed out the problems with “good” private insurance namely that it’s at the whim of employers and frequently leaves very sick people with huge bills they never acknowledged the core political reality that polls have shown repeatedly and as recently as this week: Support for Medicare for All drops dramatically when people hear that enrollment in a new government plan would be mandatory.

Beto O’Rourke, the former congressman from Texas, suggested an alternative when it was his turn to weigh in on health care. He touted what he’s been calling “Medicare for all who want it,” which would create a new government insurance program with automatic enrollment but give employers the option of offering private coverage to employees who prefer to stay out of the public program. (This is the same basic approach that Buttigieg also supports.)

“If people like me are right that the public alternative is going to be not only more comprehensive, but more affordable than any of the corporate options around there, we’ll see Americans walk away from the corporate options into that Medicare option, and it will become Medicare for All without us having to kick anybody off their insurance,” O’Rourke said.

Polling suggests that this kind of “public option” is a lot more popular than Medicare for All though, of course, public opinion can change. The Center for American Progress has put forward a version of this, as have two liberal Democrats in the House.

But the public option became a secondary story in the scrum over Medicare for All. And that could be a harbinger of things to come.