Big Ideas vs Caution: Dems Debate Medicare for All

Moderates blast "fairy tale economics" and "impossible promises"; but are they just "scared"?

  • by Washington Correspondent, MedPage Today

Is "Medicare for All" an impossible pipe dream or an achievable reality? Can a candidate who supports progressive, some say "radical," policies win against President Donald Trump? That was the crux of a protracted healthcare discussion, pitting centrist Democrats against their more liberal colleagues, during "round two" of the Democratic debate series in Detroit on Tuesday evening.

So-called moderates targeted Sen. Bernie Sanders (I-Vt.) and Sen. Elizabeth Warren (D-Mass.) for their support of Medicare for All while blasting other proposed plans such as free college for all Americans and free healthcare for undocumented immigrants.

The debate which aired on CNN, will continue Wednesday evening with a second set of Democrats including former Vice President Joe Biden, the front-runner in most recent major primary polls, according to RealClearPolitics, and Sen. Kamala Harris (D-Calif.). Sanders is in second place in recent polls, with Warren in third and Harris fourth.

Besides Sanders and Warren, participants in the Tuesday night debate included former Rep. John Delaney (D-Md.), former Colorado Gov. John Hickenlooper, Montana Gov. Steve Bullock, Rep. Tim Ryan (D-Ohio), Sen. Amy Klobuchar (D-Minn.), former Rep. Beto O'Rourke (D-Texas), Mayor Pete Buttegieg of South Bend, Indiana, and author Marianne Williamson.

Ten more Democratic candidates will debate Wednesday night.

'Impossible promises'

Even before the questions began Tuesday evening, Sanders and Warren drew sharp attacks from the other candidates, both veiled and direct.

Delaney slammed "Medicare for All and free everything" in his opening statement -- presumably referring to college tuition and healthcare -- as "bad policies" and "impossible promises" that would help President Trump get re-elected.

"That's what happened with [George] McGovern. That's what happened with [Walter] Mondale. That's what happened with [Michael] Dukakis," Delaney said, alluding to the big defeats they suffered in the 1972, 1984, and 1988 elections, respectively (though Mondale and Dukakis were considered moderates in their time).

Hickenlooper echoed Delaney, noting that none of the 40 congressional Democrats who ran Republicans out of office in 2018 supported "the policies of our front runners at center-stage," referring to Sanders and Warren.

Bullock -- joining the debates for the first time in place of Rep. Eric Swalwell (D-Calif.) who dropped out of the race earlier this month -- prodded the same front runners with an oblique reference to his opponents' "wish-list economics," while Klobuchar pledged "bold ideas" with the caveat "but they are grounded in reality."

And that was just the candidates' first 12 minutes.

'Scared' of losing

Throughout the nearly three hour debate, healthcare continued to surface and resurface.

When Delaney argued that Democrats can only win the next election by advocating "real solutions" to "kitchen table issues" like growing jobs and lowering drug prices, and "not fairy tale economics," Warren leapt to her own defense.


In her own opening remarks, Warren said "small ideas and spinelessness" can't solve America's problems, only "big structural change" can.

And when her opponents charged that many hospitals would close their doors and moderators noted that private insurance would be taken away from 150 million people with Medicare for All, she urged them to stop using "Republican talking points."

Speaking more to the voters than anyone she said, "I get it, there is a lot at stake and people are scared, but we can't choose a candidate we don't believe in just because we're too scared to do anything else."

'Throw your hands up'

Sanders and Hickenlooper also came head-to-head over the future of healthcare.

CNN's Jake Tapper, one of the debate's moderators, called on Hickenlooper to explain a Facebook ad that stated "Socialism is not the answer." Sanders is a Democratic Socialist, Tapper noted later.

Hickenlooper responded that taking private insurance away from 180 million people and promising everyone a government job, as does the "Green New Deal" -- a plan proposed by Rep. Alexandria Ocasio-Cortez (D-N.Y.) and supported by Sanders and Warren -- would be a "disaster," Hickenlooper said.

"You might as well FedEx the election to Donald Trump," he added, prompting an exchange seemingly designed to go viral on social media.

Sanders argued that "every credible poll" shows him beating Trump. Hickenlooper insisted that Americans won't stand for the "radical changes" Sanders is proposing. Sanders then threw his hands up, signalling frustration.

"Throw your hands up," said Hickenlooper, equally frustrated. "All right," Sanders said, raising his hands even higher, to applause from his fans. Hickenlooper then raised his own hands.

"Whoa, I can do it," he said, visibly annoyed.

"But you haven't implemented the plans, us governors and mayors are the ones who -- we have to pick up all the pieces," Hickenlooper continued, speaking faster, growing breathless. "When suddenly the government's supposed to take over all these responsibilities, and there's no preparation, the details aren't worked ... You can't just spring a plan on the world and expect it to succeed," he said.

Sanders pointed out that he has been a mayor and has "some practical experience."

Tuesday was the anniversary of Medicare which was implemented 54 years ago, under President Lyndon Johnson with the support of a Democratic congress. In one year, 19 million people had joined, Sanders said.

"Please don't tell me, that in a 4-year period, we cannot go from 65 down to 55, to 45, to 35," referring to the age of eligibility for the program. "This is not radical. This is what virtually every other country on earth does," Sanders said.

In another pointed exchange, Tapper noted that if Medicare for All were enacted 600,000 union members in the debate's host city would lose their private insurance. Would benefits of Medicare for All plans, Tapper asked, be "as good" as those Detroiters' current coverage?

"They will be better, because Medicare for All is comprehensive," Sanders said, noting that senior citizens under his plan would have access to dental insurance, to eyeglasses, and hearing aids.

"You don't know that, Bernie," Tim Ryan interjected.

Sanders cut Ryan short. He did know that, he said. "I wrote the damn bill."

Ryan said he meant that Sanders doesn't know every union contract in the country. Union members are losing their jobs, he said, and "the only thing they have is possibly really good healthcare."

Ryan's own plan is to lower the eligibility age for Medicare to 50 and allow people to buy in.

Drug prices, gun violence

On the related issue of drug prices, Sanders noted that Canadians pay one-tenth of U.S. prices for insulin. In a media stunt Sunday, Sanders took a group of Americans from Detroit to Canada to buy insulin.

Bullock mentioned his support for negotiating prescription drug prices, but the topic received little attention and was only mentioned tangentially as evidence of our broken healthcare system or drug companies' clout in Congress.

The opioid epidemic was mentioned directly only once when Klobuchar attacked the drug industry for getting a high school swimmer hooked on the drugs.

Gun violence came up, but the candidates largely agreed on the solutions: Universal background checks, an assault weapons ban, and "red flag" laws meant to keep guns away from individuals with a history of domestic violence or mental health issues.

When Bullock was criticized for changing his position on the assault weapons ban -- offering his support last year after previously opposing it -- he explained that he is a gun owner who has also been affected by gun violence. His 11-year-old nephew was killed on a playground.

The way to win in Congress is to remove "dark money" from campaign funding, Bullock said. This isn't just about the NRA but about corporate lobbying as well.

"Washington, D.C., is captured by dark money," he said.

Free healthcare, decriminalizing entry

Another issue featured at the debates was whether to offer insurance to undocumented immigrants.

At one of the debates last month, all 10 candidates on stage said their health plans would cover healthcare for undocumented immigrants.

When asked on Tuesday night whether offering undocumented immigrants free insurance and decriminalizing entry into the U.S., as Warren and Sanders proposed, would encourage more illegal immigration, Ryan (who wasn't part of that earlier debate) argued that it would do just that.

Ryan said that people seeking asylum should be welcomed into the country but regarding healthcare, "undocumented people can buy healthcare too."

If others are paying for it, then so should undocumented immigrants, he said.

Bullock also argued against the idea of free healthcare for immigrants. There's currently 100,000 people at the border. By decriminalizing entry and offering free healthcare to everyone, "we'll have multiples of that."

Sanders was unmoved.

"I happen to believe that when I talk about healthcare as a human right, that applies to all people in this country," he said.

Next up

Wednesday night's debate will also air on CNN and will feature former Vice President Joe Biden; Senators Cory Booker (D-N.J.), Kamala Harris (D-Calif.), Kirsten Gillibrand (D-N.Y.), and Michael Bennett (D-Colo.); New York City Mayor Bill de Blasio; Rep. Tulsi Gabbard (D-Hawaii); former Housing Secretary Julian Castro; Washington Gov. Jay Inslee; and entrepreneur Andrew Yang.