Another Democratic Debate, Another Pointless Argument About Health Care

Americans who tuned into the fourth Democratic primary debate of the 2020 presidential campaign on Tuesday expecting to hear more about the candidates’ views on health care couldn’t be blamed if they thought they were watching a rerun.

Once again, the discussion focused almost exclusively on the question of how to pay for ”Medicare  for All,” the sweeping plan to replace the current mixed private-public health coverage system in the United States with a government-financed single-payer program . 

“Will you raise taxes on the middle class to pay for it, yes or no?” New York Times national editor Marc Lacey asked Sen. Elizabeth Warren (D-Mass.).

And once again, voters were subjected to a virtually pointless trading of talking points that shed no new light on how the candidates diagnose the flaws of the U.S. health care system or how they propose to cure them. Warren and Sen. Bernie Sanders (I-Vt.) support Medicare for All . Former Vice President Joe Biden (D), Sen. Amy Klobuchar (D-Minn.), South Bend, Indiana, Mayor Pete Buttigieg (D) and the other candidates don’t .

If you’re a Democratic voter, the only reason this would be news to you is if you awoke from a coma immediately before the start of Tuesday’s debate.

Focusing a conversation about America’s deeply messed up, unaffordable and unfair health care system with a “gotcha” question about whether fixing it would require tax increases serves no one other than moderators looking to frame progressive proposals entirely around their costs.

The aim here is not to illuminate the trade-offs inherent in any health care reform proposal. It’s to create a clip of a leading candidate in this case, Warren talking about tax increases based on the assumption that tax increases are inherently bad, in the view of the people asking the question.

Sanders has spoken plainly about the need for new taxes to finance his Medicare for All plan . “At the end of the day, the overwhelming majority of people will save money on their health care bills,” Sanders said Tuesday. “But I do think it is appropriate to acknowledge that taxes will go up.”

Warren avoids the word “tax,” but it doesn’t take a genius to understand that she is saying the same thing.

“Costs will go up for the wealthy, they will go up for big corporations, and for middle-class families, they will go down,” Warren said. “I will not sign a bill into law that does not lower costs for middle-class families.” 

In other words, new taxes would target those who have lots of money and, to the extent that middle-class people see new taxes to finance Medicare for All, those will be lower than what such families pay today for health care. Sanders and Warren describe this the same way, except for the “t” word.

Voters are getting pretty sick of this argument, according to survey results the Henry J. Kaiser Family Foundation published Tuesday. Last week, 48% of Democrats and Democratic-leaning independents reported they thought the candidates were talking too much about Medicare for All. Fifty-one percent thought there was too much discussion of health coverage programs, and 45% thought there was too much talk about the Affordable Care Act .

A majority of these voters told pollsters they wanted to hear more about subjects like the cost of prescription drugs and dealing with surprise medical bills.

The organizers of the Ohio debate must not have seen that survey. 

Of course, creating a federal program that provides health coverage with no premiums, no deductibles and no out-of-pocket costs at the point of service would require tax increases. Health care that’s free when you receive it isn’t actually free. Taxpayers just pay for it in advance.

Centralizing the health coverage system would surely enable more aggressive cost-containment than is possible under the fragmented coverage system America has today. If the federal government were the sole purchaser of health care services and products, the federal government would have unparalleled power to push down the prices for those services and products. Eliminating private insurance also would do away with the money insurance companies spend on administrative costs and enriching their executives and shareholders.

Yet no serious person can claim the government wouldn’t need to raise money to finance a single-payer system. 

The real question is who would pay those taxes and how the burden of new taxes would compare to what American households are currently paying in premiums, co-payments and care their insurance plans don’t cover at all. And that’s to say nothing of the millions of uninsured Americans, who today face unlimited costs when they get sick or injured.