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Posted on October 16, 2019 at 3:15 AM

by Craig Klugman, Ph.D.

The fourth iteration of this debate lasted over 3 hours and included 12 candidates (now fitting onto one stage–barely–on a single night). Most of them were attacking Warren, who is the current front runner according to the polls.

When it came to health care, the candidates fall into two approaches. The first is supported by Warren and Sanders, both of whom advocate “Medicare for all” a universal health care program. Warren said that this concept is “the gold standard; it’s how we get coverage for everyone”. When pressed on how she would pay for this plan, Warren said that costs would go up for wealthy and big corporations. “Costs will go down for hardworking, middle-class families”. However, she did not explain that it would require raising taxes despite moderator attempts to get her to do so. Sanders explained further “as someone who wrote the damn bill”. He said that yes, taxes will go up and significantly for the wealthy. But there would be no premiums, copayments, or deductibles. No more out of pocket expenses. Thus, he says most people will save money on their health care bills. He claims that the increase in taxes will be substantially less than what we pay for current health care costs. A new Kaiser Family Foundation poll finds shrinking public support for this option.

The other position were candidates who wanted to create a public insurance option. Buttigieg advocates, what he calls, “Medicare for all who want it”. His idea is that people can buy into the public system (with subsidies if needed) or they can choose to buy insurance through the private system we currently have. He says that people want a choice, not being forced into a single system.

Klobuchar wants to build on the Affordable Care Act but to build in a public option that would be available everyone. She also wants to take on the pharmaceutical companies to reduce drug costs. She said that we are dealing with a “silver surge” that will require more long-term care options and to strengthen Medicare. She also wants to take opioid manufacturers to task for creating our current addiction crisis.

The other major health topic discussed in the debate was on abortion and reproductive rights. The CNN moderators framed the question in terms of how the candidates would deal with restrictive laws like Ohio’s fetal heart beat ban bill (which is currently enjoined by the courts). All of the candidates who were asked supported a women’s right to choose and reproductive freedom. As Harris said, “People have to keep their hands off of women’s bodies and let them make their own decisions.” The other common answer was to codify Roe v. Wade into federal law. Klobuchar mentioned that she would refund Planned Parenthood. Booker would create an office of reproductive freedom and repeal the Hyde Amendment. Gabbard said she would keep abortion unavailable in the third trimester except to save the mother’s life. Harris said that she would order the DOJ to review any law (pre-clearance) proposed by a state that would violate Roe v. Wade.

Some of the debate revolved around social inequality in income and opportunity, all of which has implications for health as well.

The next debate is November 20th in Atlanta.

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