“It sounded like massive confusion and a cacophony of sometimes right but often oversimplified or incorrect characterizations of the American health-care system,” said Harold Pollack, a health-care expert at the University of Chicago. “It is virtually impossible to honor the complexity of health policy when you have 10 men and women who have 30 seconds to respond to a random burst of questions.”
Liberal voters have consistently demonstrated an appetite for candidates who can fix the nation’s health-care system. Close to 90 percent of Democrats and Democratic-leaning independents said it was “very important” for them to hear the candidates’ views on health care, the top-ranking issue, according to a June poll from the Kaiser Family Foundation.
But the debates often generated more heat than light on the issue. Perhaps more than any other issue, health care produced repeated divisions in the debates — with some of the race’s liberal candidates vying to create a Medicare-for-all government health plan for all Americans, while others argued doing so is impractical and would push the party too far to the left.
On both sides of that intraparty rift, candidates overstated their case or glossed over key details in their plans.
On the debate’s first night, former congressman John Delaney (D-Md.) claimed that every hospital in America would close if the country paid Medicare insurance rates on every insurance plan. He argued, “So to some extent, we’re supporting a bill that will have every hospital closing.”
Health-care experts quickly dismissed the claim, given that under a single-payer system the government could control insurance rates and prevent hospitals from going out of business. Brian Riedl, a senior fellow at the conservative Manhattan Institute who has strongly opposed a single-payer system, said many hospitals could close under the plan but that Delaney’s claim was an exaggeration. PolitiFact rated the assertion as “false.”
On Thursday, Sen. Michael F. Bennet (D-Colo.) suggested it would be difficult for America to emulate Canada’s single-payer health-care system because “there are 35 million people in Canada,” compared with 330 million people in the United States.
Bennet noted that a public-option plan in the United States could have upward of 30 million people. But because America is larger than Canada and has a much larger economy, it can also raise taxes more easily to fund the system than its northern neighbor, experts said.
“It’s like saying the size of the United States makes it impossible to have a public high school system. It’s not an important factor,” said Adam Gaffney, a Harvard Medical School health-care expert and supporter of a single-payer system.
Several candidates touted plans for a public option, or “Medicare for all who want it,” as Pete Buttigieg, mayor of South Bend, Ind., put it. But left unaddressed were glaring questions about the wide variety of possible public-option plans that could be implemented, said Larry Levitt, a health-care expert at the Kaiser Family Foundation.
Few of the candidates pushing this solution grappled with those questions, crucial to the design of the overhaul of the health-care system.
“Saying people should be able to sign up for Medicare if they want it doesn’t begin to address the key questions, such as: ‘Who would be eligible? What would they have to pay? How much coverage would they get?’ ” Levitt said. “The public-option plans are all over the map . . . You can’t have a debate on how to reform this system with a bumper sticker.”
A number of candidates appeared to back away from plans they have supported as members of Congress.
Sens. Cory Booker (D-N.J.) and Kirsten Gillibrand (D-N.Y.), as well as Reps. Tim Ryan (D-Ohio) and Tulsi Gabbard (D-Hawaii), have co-sponsored single-payer legislation that would outlaw almost all private health insurance coverage. But when asked by the moderators whether they would support banning private health insurance as part of Medicare-for-all, none of the four raised a hand.
“A lot of the candidates seem to be unsure or cagey about exactly what Medicare-for-all would mean, and it’s hard to know which ones are confused and which ones are exploiting the fact that the general public might not know,” said Robert Hockett, a public policy expert at Cornell University. “There’s a big gap in the public understanding on what Medicare-for-all would entail or wouldn’t, and some of the candidates seem to be unclear on that or capitalizing on the ambiguity.”
The race’s most vocal advocates of a single-payer system also skirted key questions about what could be the largest government expansion in U.S. history. Asked how he would pay for such vast government programs, including Medicare-for-all, Sen. Bernie Sanders (Vt.) said: “Every proposal that I have brought forth is fully paid for.”
Yet Sanders’s Medicare-for-all proposal, which he introduced in the Senate, does not lay out in detail how much it would cost and falls short of paying for the program in full.
Sanders also pointed to other countries with single-payer systems, including Canada, to defend his plan. “I find it hard to believe that every other major country on Earth, including my neighbor 50 miles north of me, Canada, somehow has figured out a way to provide health care to every man, woman, and child, and in most cases, they’re spending 50 percent per capita what we are spending,” Sanders said.
But Sanders’s plan would go further in handing government control of health care than other countries with socialized medicine, which still have some role for private insurance, by abolishing it altogether.