Justin Sullivan/Getty Images
En español | Ten Democrats who want to be the next president of the United States agreed on a debate stage in Detroit Tuesday night that all Americans should have affordable health care. But they disagreed on what's the best way to make that happen.
The division among Democrats who want to fix or augment private health insurance with a public option and those who favor scrapping private plans while creating a government-run system reflects the divided sentiments of many Americans on this issue. A July health care public opinion survey by the nonpartisan Kaiser Family Foundation found that 83 percent of Americans have a positive opinion of Medicare and at the same time 76 percent of Americans support employer-sponsored private insurance. This new poll also illustrated how the public is divided on Medicare-for-all with 51 percent supporting such a system.
Sens. Bernie Sanders and Elizabeth Warren both want to do away with private insurance and replace it with a government-run single payer system and their plan dominated discussion at the beginning of the debate.
"As people talk about having insurance, there are millions of people who have insurance, they can't go to the doctor, and when they come out of the hospital, they go bankrupt,” said Sanders, who authored the Medicare-for-all bill now in Congress. “Nobody can defend the dysfunctionality of the current system."
Warren took aim at insurance companies. “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. “That is not working for Americans."
Marianne Williamson, who previously has said that she supports Medicare-for-all, said she was concerned that embracing that plan “will make it harder to win” the presidency in 2020.
The other Democratic hopefuls challenged the Medicare-for-all proposal, arguing that it is unrealistic to make such a massive change and that millions of Americans like their employer-sponsored health care and shouldn't be forced to give it up.
"We should deal with the tragedy of the uninsured and give everyone health care as a right,” said former Maryland congressman John Delaney. “But why have we got to be the party of taking something away from people?” he asked, referring to what he said are half the American people who get their health insurance through their job and like it.
"The fact of the matter is, tens of millions of people lose their health insurance every single year when they change jobs or their employer changes that insurance,” Sanders countered.
The debate on CNN featured Sanders, Warren, Williamson, Delaney and Montana Gov. Steve Bullock, South Bend, Indiana, Mayor Pete Buttigieg, former Colorado Gov. John Hickenlooper, Minnesota Sen. Amy Klobuchar, former Rep. Beto O'Rourke (Texas) and Rep. Tim Ryan (Ohio). Ten more Democrat candidates will take the same stage Wednesday evening.
Bullock brought the high price of prescription drugs into the discussion, saying, “We pay more for prescription drugs than any place actually in the world. We got nothing to show for it. Negotiate prescription drug prices. End surprise medical billing. That's the way that we can get there without disrupting the lives of 160 million people that like their employer-sponsored health insurance."
Several of the candidates used the Medicare-for-all question to explain their solution to moving the country to universal health care coverage.
"We need the public option” that President Obama could not get into the Affordable Care Act, said Klobuchar. “Clearly, this is the easiest way to move forward quickly, and I want to get things done. People can't wait.” Klobuchar, as did some of the other candidates, told a personal story about health care, specifically about the high cost of prescription drugs. “I've got my friend, Nicole, out there,” she said, “whose son actually died trying to ration his insulin as a restaurant manager. And he died because he didn't have enough money to pay for it."
Buttigieg's idea is called Medicare for All Who Want It. “We don't have to stand up here speculating about whether the public option will be better or a Medicare for All environment will be better than the corporate options,” he said. “We can put it to the test.” Under his plan the public could decide whether to keep their insurance or join Medicare, which Buttigieg believes will be “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 under his Medicare for America plan everyone who is uninsured “would be enrolled in Medicare tomorrow…. When we listen to the American people — and this is what they want us to do — they want everyone covered, but they want to be able to maintain choice.” He said it's a “false choice” to pit Medicare-for-all against the current insurance-based system.
Hickenlooper agreed that if the public is offered a choice, the system will move toward Medicare-for-all. “I think proposing a public option that allows some form of Medicare that maybe is a combination of Medicare Advantage and Medicare, but people choose it, and if enough people choose it, it expands, the quality improves, the cost comes down, more people choose it, eventually, in 15 years, you could get there, but it would be an evolution, not a revolution."