Updated: Sep 14, 2019
Last night was the latest of the Democratic Presidential Debates. Rather than having 2 nights of debates, this one night event only included the top 10 candidates. As might be expected, healthcare was again a controversial topic among the debaters. Many candidates stuck to their initial plans and continued to defend them against attacks from challengers. While the messages remained mainly the same, the hope was that the candidates might add some additional details to give the American public a better understanding of each. Some did, but many did not. Below is a quick review of where the candidates stand and what they added during last night’s debate.
Elizabeth Warren, Bernie Sanders, Julian Castro & Cory Booker: Both Ms. Warren and Mr. Sanders have long supported the Medicare for All plan that would eliminate the private insurance system and opt all Americans into the Medicare System. Both were pushed to describe where the funding for such plans would come from and the answers were vague, at best. Mr. Booker and Mr. Castro did not add a lot to this portion of the debate, other than their support for Medicare for All and the concern that expanding the ACA would force people to opt in to coverage rather than automatically enrolling them.
Joe Biden, Pete Buttigieg, and Amy Klobuchar: All three of these candidates supported expanding on the Affordable Care Act and including a public option. All three wanted to ensure that the American people had a choice of private or public insurance. Vice President Biden, the largest proponent of this plan, spent most of his healthcare related debate time questioning how Medicare for All would be paid for and defending his plan, particularly this requirement to opt in.
Beto O’Rourke: Mr. O’Rourke promoted his Medicare for America plan that would automatically enroll those that were uninsured into Medicare immediately. Beto was the only member of the group to bring up the mental health crisis, but provided few answers on how to combat this problem.
Kamala Harris: Ms. Harris proposed a Medicare for All Who Want It plan. Her major focus during the healthcare portion of the debate was President Trump and what he has attempted to do during his term.
Andrew Yang: Mr. Yang spoke about pay for performance and used the Cleveland Clinic as his example. This has been a popular topic in healthcare reimbursement policy, but he did not include any additional information.
As described above, the two major plans among the candidates are Medicare for All and the Expansion of the Affordable Care Act. Both of these plans have benefits, including universal coverage, but they are still vague. One of the biggest concerns has to be the impact of this legislation on physicians and those who practice medicine.
Universal coverage is wonderful, but what if reimbursements are so low that physicians cannot stay in business and suddenly there are particularly long waits for patients to see a doctor? What will be done to increase the number of physicians in the country, especially in rural, under-served areas and under-represented specialties? A couple of the candidates mentioned the unnecessary burden placed on physicians to work with insurance companies - what will be done to ensure that physician do not continue to have these burdens? The elimination of private insurance companies does not mean the elimination of paperwork and hoops for physicians and healthcare workers to be paid appropriately.
Right now, there are many questions that are left unanswered for both policies, especially related to their impact on healthcare providers, and it's incredibly important that we continue to push for these answers.