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Posted on June 28, 2019 at 2:50 PM

by Craig Klugman, Ph.D.

Wednesday and Thursday nights this week saw a gathering of twenty candidates pursuing the Democratic nomination to run for President of the United States in 2020. Each night, ten candidates discussed hot button issues and current events that are of importance to many Americans. Many of these topics have direct bearing on bioethics and health.

In the area of bioethics, most of the candidates stated that there is a lack of ethical or moral foundation in the executive branch. This is not a call for religion, but rather an acknowledgement of the many conflicts of interest and cases of corruption that define the daily operations of the current administration. Thus, most candidates called for a return to ethics (defined both as following the civil law and aiming to do what is right) in government.

In regards to health care, all candidates believed that more work was needed to improve insurance coverage and access to medical care. They all held that medical care is a human right, not a privilege. All but one of the candidates would increase the federal government’s involvement in this arena. Several endorse “Medicare for all,” which is a plan that would allow (and eventually require) people under the age of 65 to buy in to the current Medicare system. It would (either quickly or on a longer clock) replace private health insurance. The goal would be to have universal health insurance coverage through an efficient and economical government run system. However, with administrative costs (i.e. profits) of much private insurance topping 15% of the cost of insurance, the federal government could administer the program for far less overhead and without a profit motive. While this would cover a larger percent of people than our current private patchwork, other candidates pointed out that it would require increased taxes (offset by no longer paying premiums, co-pays, and minimums) and would face challenges of scale—most countries with a single payer system are far smaller in population than the U.S.

Other candidates suggested adding a public option to the ACA marketplace. In many geographic areas, there is only one or two providers available for the subsidized insurance marketplace. A public option would allow people to purchase a government-run health care plan. This plan would be offered alongside other private options.

Two candidates talked about taking care of loved ones at the end of life—they want to do more to help people who are dying so that it does not seem like we abandon them. And all candidates said that they would include undocumented immigrants in their health plan, a population that the Affordable Care Act excludes. Candidates also touch on the opioid crisis, the high cost of prescription drugs, and abortion access (most supported this).

In other areas, the candidates spoke about economic injustice—too much wealth is concentrated in the top 1% (even more than that, it is the top 0.1%, but decimals make for poor clips). They all spoke out against arresting and incarcerating people coming to the U.S. border to seek amnesty, especially the policy of separating children from their family and placing them into concentration camps. And several talked about alleviating the burden of the cost of college from free public college, to free community college, to more Pell grants, to forgiving student loan debt.

A broader perspective offers that the women were much more polite than the men (they did not, for the most part, talk over someone else, pull the focus from the person speaking, or criticize other candidates). My other observation is that ageism is alive and well—a few candidates suggested that since the older generation created the policies that have led to so many problems, that it is was time to “pass the torch” to a generation that will solve them. What is behind this comment is a judgement on age: Sanders is 77, Biden is 76, and Warren is 70. Also, racism is an important issue, especially when we in the midst of an administration the code speaks in such tones. Consider that Biden called Booker “boy” (outside of the debate) or that Harris had to call attention to being black to be able to speak about racism (specifically education and busing).

When asked to name the biggest threats to the U.S., the candidates generated a list that included China, Russia, climate change/crisis, gun violence, and Donald Trump. Two of these are public health issues and if they are treated as such, we might be able to move forward. For now, health issues are being treated as political points meaning not much will be done and rather than coming together, we will remain divided.

With a year and a half until the next Presidential election, there will be more debates and more chances to learn what the candidates believe on important health policy issues. Stand by.

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