Health care question divides Democratic field

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During Wednesday evening’s Democratic presidential debate, a question on which candidates would support eliminating private health insurance marked the first apparent policy difference among the contenders. Only two hands — those of Sen. Elizabeth Warren and New York City Mayor Bill de Blasio — went up. Warren, who had drawn criticism from some on the left for having a muddied health care position, made an impassioned case when moderator Lester Holt asked her about Sen. Bernie Sanders’s Medicare for All bill, which she co-sponsored.

“I’m with Bernie on Medicare for All and let me tell you why,” said Warren. “I spent a big chunk of my life studying why families go broke, and one of the number one reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance, it’s for people who have insurance. Look at the business model of an insurance company: It’s to bring in as many dollars as they can in premiums and to pay out as few dollars as possible for your health care. That leaves families with rising premiums, rising co-pays and fighting with insurance companies to try and get the health care that their doctors say that they and their children need. Medicare for All solves that problem.”

Sen. Elizabeth Warren, D-Mass., attends a Senate Armed Services Committee hearing in Dirksen Building titled ‘Foreign Cyber Threats to the United States,’ featuring testimony by Director of National Intelligence James Clapper and others, January 5, 2016.

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Senate Armed Services Committee members (L-R) Sen. Martin Heinrich (D – NM), Sen. Elizabeth Warren (D-MA) and Sen. Gary Peters (D-MI) talk during a hearing in the Dirksen Senate Office Building on Capitol Hill January 5, 2017 in Washington, DC. The intelligence chiefs testified to the committee about cyber threats to the United States and fielded questions about effects of Russian government hacking on the 2016 presidential election.

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Senate Armed Services Committee Chairman John McCain (R-AZ) (L) and Sen. Elizabeth Warren (D-MA) arrive for a hearing with the Director of National Intelligence and National Security Agency chief in the Dirksen Senate Office Building on Capitol Hill January 5, 2017 in Washington, DC. The intelligence chiefs testified to the committee about cyber threats to the United States and fielded questions about effects of Russian government hacking on the 2016 presidential election.

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Democratic Nominee for President of the United States former Secretary of State Hillary Clinton, accompanied by Senator Elizabeth Warren (D-MA), speaks to and meets New England voters during a rally at Saint Anselm College in Manchester, New Hampshire on Monday October 24, 2016.

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Mark Wahlberg, Former Boston Police Commissioner Ed Davis, Boston Police Commissioner Billy Evans, Former Boston Red Sox player David Ortiz, Dun ‘Danny’ Meng, Jessica Downes, Patrick Downes, Senator Elizabeth Warren, director Peter Berg and Harvard Law professor Bruce Mann pose on the red carpet at the ‘Patriots Day’ screening at the Boch Center Wang Theatre on December 14, 2016 in Boston, Massachusetts.

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Democratic Nominee for President of the United States former Secretary of State Hillary Clinton, accompanied by Senator Elizabeth Warren (D-MA), speaks to and meets New England voters during a rally at Saint Anselm College in Manchester, New Hampshire on Monday October 24, 2016.

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Former Red Sox player David Ortiz talks with Senator Elizabeth Warren at the ‘Patriots Day’ screening at the Boch Center Wang Theatre on December 14, 2016 in Boston, Massachusetts.

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Democratic presidential nominee Hillary Clinton and Senator Elizabeth Warren hold a rally at St. Anselm College in Manchester, NH on Oct. 24, 2016.

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U.S. Senator Elizabeth Warren speaks at a Manchester ‘New Hampshire Together’ Canvass Launch event in Manchester, NH on Sept. 24, 2016.

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Senior United States Senator from Massachusetts, Elizabeth Warren speaks onstage at EMILY’s List Breaking Through 2016 at the Democratic National Convention at Kimmel Center for the Performing Arts on July 27, 2016 in Philadelphia, Pennsylvania.

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US Senator Elizabeth Warren, Democrat of Massachusetts, holds up copies of Wells Fargo earnings call transcripts as she questions John Stumpf, chairman and CEO of Wells Fargo, as he testifies about the unauthorized opening of accounts by Wells Fargo during a Senate Banking, Housing and Urban Affairs Committee hearing on Capitol Hill in Washington, DC, September 20, 2016.

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Sen. Elizabeth Warren (D-MA) along with members of the Democratic Women of the Senate acknowledge the crowd on the fourth day of the Democratic National Convention at the Wells Fargo Center, July 28, 2016 in Philadelphia, Pennsylvania. Democratic presidential candidate Hillary Clinton received the number of votes needed to secure the party’s nomination. An estimated 50,000 people are expected in Philadelphia, including hundreds of protesters and members of the media. The four-day Democratic National Convention kicked off July 25.

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Sen. Elizabeth Warren (D-MA) delivers remarks on the first day of the Democratic National Convention at the Wells Fargo Center, July 25, 2016 in Philadelphia, Pennsylvania. An estimated 50,000 people are expected in Philadelphia, including hundreds of protesters and members of the media. The four-day Democratic National Convention kicked off July 25.

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Representative Joseph P. Kennedy III welcomes Massachusetts Senator Elizabeth Warren on stage on Day 1 of the Democratic National Convention at the Wells Fargo Center in Philadelphia, Pennsylvania, July 25, 2016.

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Former Secretary of State Hillary Clinton accompanied by Senator Elizabeth Warren (D-MA) speaks to and meets Ohio voters during a rally at the Cincinnati Museum Center at Union Terminal in Cincinnati, Ohio on Monday, June 27, 2016.

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The Late Show with Stephen Colbert airing live, Thursday July 21, 2016 in New York. With guest Elizabeth Warren .

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Sen. Elizabeth Warren (D-MA) arrives in the Capitol for the on Tuesday, June 28, 2016.

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U.S. Sen. Elizabeth Warren (D-MA) (R) meets with Supreme Court nominee Merrick Garland (L), chief judge of the D.C. Circuit Court, April 14, 2016 on Capitol Hill in Washington, DC. Garland continued to place visits to Senate members after he was nominated by President Barack Obama to succeed the late Justice Antonin Scalia.

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Senator Elizabeth Warren, a Democrat from Massachusetts, listens as Janet Yellen, chair of the U.S. Federal Reserve, testifies during a Senate Banking Committee hearing in Washington, D.C., U.S., on Tuesday, June 21, 2016. Yellen offered a subtle change to her outlook from less than a week ago, saying she and her colleagues were on watch for whether, rather than when, the U.S. economy would show clear signs of improvement.

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Sen. Elizabeth Warren, D-Mass., greets guests during a rally on the east lawn of the Capitol to urge Senate Minority Leader Mitch McConnell, R-Ky., to hold a vote on the ‘Seniors and Veterans Emergency Benefits Act,’ March 9, 2016. The legislation would provide a one time payment to seniors, veterans and other SSI recipients who will not get a cost-of-living adjustment this year.

(Photo By Tom Williams/CQ Roll Call)

Senators Bob Corker (L) and Elizabeth Warren (R) speak before a Senate Banking Committee on the semiannual monetary report to Congress hearing in Washington, USA on February 11, 2016.

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Senator Elizabeth Warren (D-MA), talks with Rep. Elijah Cummings (D-MD) in the House chamber prior to President Obama’s State of the Union speech on Capitol Hill in Washington, February 12, 2013.

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“And I understand,” added Warren. “There are a lot of politicians who say it’s just not possible, we just can’t do it, have a lot of political reasons for this. What they’re really telling you is they just won’t fight for it. Well, health care is a basic human right and I will fight for basic human rights.”

The universal coverage proposal Warren championed would eventually end Medicare as it exists, along with Medicaid and private insurance, replacing them with a health care plan that would cover all patient bills without the need for supplemental insurance. The Medicare for All plan, as outlined, would cover routine doctor visits, surgery, mental health, prescription drugs, dental and vision for everyone in America. It would also cover women’s health services such as abortion, a controversial position that would require the repeal of the Hyde Amendment, which prevents federal money to be used for abortions.

Sen. Amy Klobuchar of Minnesota then made the case for a public option, pointing out that that was the position of President Barack Obama in the early stages of passing the Affordable Care Act. She said she was “simply concerned about kicking half of America off their health insurance in four years, which is exactly what this bill says.”

The basic idea for a public option is to allow some or all Americans the option to buy into a public Medicare or Medicaid-style plan if not the programs themselves. Supporters of the public option say it would allow those who like their private insurance plans to keep them and reduce the disruption to the economy. Supporters of a single-payer plan like Medicare for All say that a public option is simply another incremental step, like Obamacare, that perpetuates the power and profits of the private insurance industry while failing to achieve universal coverage.

Former Texas Rep. Beto O’Rourke, who had supported Medicare for All in the House, said he had changed his position and wouldn’t eliminate private insurance, because he wanted Americans, particularly those who had negotiated plans through unions, to have a choice. He was cut off by de Blasio, prompting the first real exchange between candidates of the evening.

“Congressman O’Rourke, private insurance isn’t working for tens of millions of Americans when you talk about the co-pays, the deductibles, the premiums, the out-of-pocket expenses, it’s not working,” said de Blasio. “How can you defend a system that’s not working?”

At this point former Maryland Rep. John Delany joined the conversation.

“It should be noted that 100 million Americans like their health insurance, by the way,” said Delaney. “I think we should be the party that keeps what’s working and fixes what’s broken. Doesn’t that make sense? We should give everyone in this country health care as a basic human right for free, full stop. But we should also give them the option to buy private insurance, why do we have to stand for taking away something from people.”

Other candidates offered slightly different approaches. Sen. Cory Booker of New Jersey said he supported Medicare for All (he’s also a co-sponsor of the Sanders bill), but that he favored getting there over a series of steps, while Washington Gov. Jay Inslee pointed out that his state had passed a public option. Holt asked former Housing and Urban Development Secretary Julian Castro if his plan would cover abortion, to which Castro said, “Yes,” and that he believed in “reproductive justice.”

“What that means is just because a woman or let’s also not forget someone in the trans community, a trans female, is poor doesn’t mean they shouldn’t have the right to exercise that right to choose, so I would absolutely cover the right to have an abortion,” said Castro, to cheers.

The American health care system is among the most expensive in the world, and has some of the highest prescription drug costs. At the same time, 28 million people are without health coverage and 79 million have medical debt, while crowdfunding sites to cover medical expenses are proliferating.

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