Last night, we watched the first night of the Democratic Presidential Debates. Of course, healthcare was the first major topic that was covered and has become one of the most defining issues, even within the same party. The debate primarily hinges on whether or not “Medicare for All” is the correct policy to move forward under. All candidates agree that universal coverage is a basic human right, but that is where the similarities end.
Now, if you have ever watched a political debate, you know that they are frustrating because the talking points are short, argumentative and don’t allow for much detail. There is a great deal of deflecting and story telling to get around answering direct questions. The first night of the debates was no exception. So we will talk about the candidates, their plans as they explained tonight.
Bernie Sanders: Bernie is one of the major proponents of Medicare for All. He believes in a government system, which he compared to the Canadian system and came out swinging to defend his plan - and the audience clearly sided with him. He admitted to raising taxes for middle class individuals to make this plan a reality, but said that they would replace the current premiums, copays, and deductibles that patients pay out of pocket.
Elizabeth Warren: Ms. Warren is the other large proponent of Medicare for All. During the debate, she deflected quite a bit, but when pressed admitted the the Medicare for All plan, as she designed it, would be funded by increased costs for billionaires and corporations. She tried to use real life examples to make her point, but was cut off by the moderators.
John Delaney: Mr. Delaney was the loudest adversary against Medicare for All. He proposed a public option that built upon the Affordable Care Act. He argued that it was not fair to take away private insurance for those that prefer it.
Pete Buttigieg: Mr. Buttigieg supported a “Medicare for All Who Want It” plan that allowed individuals to stay on their private plans, but also have an option to join Medicare. He also agreed that people will have to pay for the plan, but it should make no difference if it is through taxes or premiums. He did not provide any additional details and was largely silent throughout the rest of the healthcare debate.
Beto O’Rourke: Beto was the only candidate who provided a firm answer on the idea of increasing taxes for the middle class to pay for universal health care coverage - No. He then proposed a “Medicare for America” plan that puts all uninsured on Medicare “tomorrow.” This sounded similar to Medicaid expansion that was put through during the Affordable Care Act, but has not been implemented in many states. He was quiet for the rest of the healthcare section of the debate and did not offer details.
The other candidates, Steve Bullock, John Hickenlooper, Amy Klobuchar, Tim Ryan, and Marianne Williamson, were largely silent during the healthcare portion of the debate.
The biggest question facing the healthcare plans throughout Democratic debates is funding. Where do you come up with the money to pay for these plans? Many candidates in this debate deflected, provided vague answers or simply ignored this question during their responses. This is a huge deal - no plan presented during the debate is free and it is a concern.
The other question that I really wanted answered is how do these plans impact healthcare providers, to include physicians, private practice, health systems and hospitals? Many practices take Medicare and appreciate that it is paid timely, but it is no secret that private insurance pays more than Medicare. John Delaney mentioned quickly that rural hospitals are unable to keep doors open if they are only paid at Medicare rates and I think that he’s correct - many rural facilities are already struggling and a decrease in reimbursements can hit them hard. Family Medicine physicians, already in short supply, are struggling to keep practices afloat with low reimbursements and this is going to be a big concern for all physicians who currently accept private insurance. There was constant talk of the billions of dollars the healthcare industry makes, but the only entities really referred to were pharmaceutical and insurance companies. We have to consider those who provide the delivery of healthcare services.
Let us know your thoughts on the debate and keep an eye out for our summary of the 2nd night - airing tonight, July 31st.