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3rd Democratic Debate: Medicare for All as the Bogeyman? (1/3)

September 13, 2019

The third Democratic Party's presidential debate featured all ten front-runners for the first time. In segment one of our debate discussion, we take a closer look how candidates discussed the healthcare issue. Our panelists are Osita Nwanevu, Helena Olea, and Jacqueline Luqman, with Greg Wilpert as host

The third Democratic Party's presidential debate featured all ten front-runners for the first time. In segment one of our debate discussion, we take a closer look how candidates discussed the healthcare issue. Our panelists are Osita Nwanevu, Helena Olea, and Jacqueline Luqman, with Greg Wilpert as host



3rd Democratic Debate: Medicare for All as the Bogeyman? (1/3)

Story Transcript

GREG WILPERT: Welcome to The Real News Network. I’m Greg Wilpert in Baltimore.

The ten Democratic Party candidates, who are ahead in terms of opinion polls and fundraising, held a third presidential debate on ABC Television on Thursday. It took place in Houston, Texas at Texas Southern University, a historically black university. The over two and a half hour debate covered a wide variety of issues; such as health care reform, racism, gun control, immigration reform, foreign policy and education reform. Notably absent were questions on climate change and economic policy.

Here at The Real News Network, we have been providing analyses of the presidential debates so far with a changing roster of panelists. Today we have joining us here in the studio, Jacqueline Luqman. She’s a host and producer here at The Real News Network as well as the editor of the website Luqman Nation. Also in the studio is Osita Nwanevu. He’s a staff writer at The New Republic and a former staff writer at The New Yorker and Slate. And then remotely, we have Helena Olea joining us. She is an international human rights lawyer with the Alianza Americas and she is a Lecturer at the University of Illinois at Chicago in the Departments of Criminology, Law and Justice. Thanks to all three of you for joining us today.

JACQUELINE LUQMAN: Thank you.

HELENA OLEA: Thank you.

GREG WILPERT: So we cannot cover everything that was discussed in this debate. And so we decided not to focus on this horse race that so many other people focus on. That is, who got under whose skin or who won the debate? Rather, we want to dig a little bit deeper into the actual issues that were discussed. So in this first segment, we start with the topic of healthcare reform, which has been a persistent issue in this presidential campaign.

SENATOR AMY KLOBUCHAR: While Bernie wrote the bill, I read the bill. And on page eight, on page eight of the bill, it says that we will no longer have private insurance as we know it. And that means that 149 million Americans will no longer be able to have their current insurance.

SENATOR ELIZABETH WARREN: Insurance companies last year sucked $23 billion in profits out of the system. How did they make that money? Every one of those $23 billion was made by an insurance company saying “no” to your healthcare coverage.

GEORGE STEPHANOPOULOS: Mayor Buttigieg—

MAYOR PETE BUTTIGIEG: The problem, Senator Sanders, with that damn bill that you wrote and that Senator Warren backs, is that it doesn’t trust the American people. I trust you to choose what makes the most sense for you.

SENATOR BERNIE SANDERS: There’s 150 million people on private insurance. 50 million of those people lose their private insurance every year when they quit their jobs or they go unemployed or their employer changes their insurance policy. So if you want comprehensive health care, freedom of choice regarding doctor or hospital, no more than $200 a year for prescription drugs, taking on the drug companies and the insurance companies, moving to Medicare for All is the way to go.

GREG WILPERT: So it seems like one of the main dividing lines between the candidates are those who like to say, or who would like Medicare for All— that is, universal health care— and that they would like it to replace all private insurers. And that’s basically the position of Sanders and Warren versus everyone else who would like to expand Medicare or some version of it and keep private insurance. So let’s start with you, Osita. What’s your take on this distinction between the candidates on this issue and how they’re talking about it?

OSITA NWANEVU: Well, this has been front and center, I think, at just about every debate that’s happened so far. It used to be the case that when people talked about Medicare for All the big debate was, “well, how are you going to pay for it? How are you going to absorb the cost of creating this new government system?” Now it seems the critics of Medicare for All have shifted into this debate about whether private insurance gets kept under the new system, and it’s not a trivial distinction substantively or politically.

If you look at polls done by the Kaiser Family Foundation and other groups, most Democrats do support Medicare for All, just the idea of it in general. But when you ask them, “Do you support a system in which private insurance will be eliminated,” numbers start to go down. People who criticize Medicare for All say that this is inherently an inbuilt risk of advocating for the program. This means that people aren’t going to be willing to get on board with the system, the kind that Sanders is proposing.

I think what’s actually reflected in that number is something that Sanders and Warren both got at. People don’t really love Aetna. They don’t really love Blue Cross/Blue Shield. That number is there because people are worried that a new system will create a kind of instability. But if Sanders and Warren can assure people that in the new system everybody’s going to keep insurance, maybe not their private insurer, but insurance, and they’re going to be able to go to whatever doctor they want to, that might be something that reassures people who might be wary about the private insurance number.

GREG WILPERT: I mean, I think it’s interesting that this issue doesn’t seem to come out very clearly as to what the debate is really about. I mean they don’t seem to be able to get that message across, that this is really the core of the problem. And then they keep proposing it as if it was a fault in the system that they’re proposing. What’s your thought on this, Jackie?

JACQUELINE LUQMAN: So the problem with the way the Democrats are framing their resistance to Medicare for All is very interesting and it’s based on what Amy Klobuchar actually said. Now, she referenced the actual language in the bill to make the argument that Medicare for All, the Sanders’ bill and the bill that Warren backs, will eliminate private insurance altogether. But according to her own words, that’s not what the bill actually says. She said that on page eight of the bill that Sanders wrote, that we will no longer have private insurance as we know it.

So it’s not that under Medicare for All, private insurance will not exist anymore. It is that the way we operate in this system of relying primarily on private insurance for health care coverage, will not exist as it does now. Because if everyone is ostensibly covered under Medicare for All, then private insurance will not be a primary source of coverage. I think that’s a major distinction, but it’s a fine point that unless you really listening, you miss. And the Democrats are playing that up, I think very craftily, but I think it’s one that we really need to pay attention to.

GREG WILPERT: Helena, I want to turn to you. What do you think? What do you make of this kind of debate on this particular issue?

HELENA OLEA: I think it’s very interesting to go back to the point that workers do not choose their insurance, as it has been presented. I think that in that element in particular, Bernie was very good in stressing with the numbers that workers do not have a choice. It’s really the employer who chooses among plans and then presents to them, sometimes a limited choice between two or three insurances at best, in really large employers.

So I think that what we should be discussing here is coverage and quality of healthcare. The discussion is not about choosing— As some others have said, no one really cares about your insurance company. You do not feel you are being well-treated by your insurance company. And I think that Warren’s point about the profit that insurance companies make really addresses that argument, but they do have to present it differently. This idea that the government is choosing for you, rather than choosing yourself, has kind of taken over this discussion and it’s very unfortunate. It’s not the main point.

GREG WILPERT: Yeah, I think that’s a very interesting point. You want to add—

OSITA NWANEVU: I think I’d just say too, one of the things that escapes notice in this discussion is that if you look at the plans that are being offered by the other candidates— you know, Pete Buttigieg and people who have offered what they say are more moderate versions of Medicare for All— their plans also point to a world in which private insurance doesn’t exist or is radically eliminated. It’s just on the longer timeframe.

I mean, if you look at what Pete Buttigieg says at the last debate, he says that he prefers a system in which we create a robust public option, and if the public option really is good and it’s cheaper than what’s available in the private market, then most Americans are going to choose that and that undermines the private insurance system. Well, that’s still – it’s essentially what Sanders is saying he’s going to do automatically or from the get-go. Buttigieg just wants to stretch that out.

And I think politically, if you’re concerned about the Sanders plan, is that Republicans are going to attack it and conservatives are going to attack it as something that eliminates private insurance. I don’t think the Buttigieg plan fools them into not doing that or reassures people. Once the message gets out that just like Sanders, Buttigieg or Beto or whoever’s offering a public option plan, it’s also going to take us to a world in which private insurance doesn’t really exist.

So I think people should just be forthright and have a discussion about the role they envision private insurance playing in the system in terms of what private insurance is actually supposed to be doing in the healthcare system. Offer a defense of what Elizabeth Warren talked about. The fact that all of this profit in the industry is a product of private insurance companies saying “no” to certain services, “no” to different treatments. Offer a defense of that or debate the issue more directly than just scaremongering about the Sanders plan because I don’t think I really serves anybody very well.

GREG WILPERT: Yeah, I mean that’s really interesting, the things that they leave out. I mean, and just as Helena mentions, the fact that there’s also no choice. And the other thing that seems to me that is being left out of this discussion is kind of the class dimension. What I mean specifically is that if you keep private insurance, then you’re going to have a system I guess where the people who can afford the private insurance or who want doctors who charge way more than they would under the public option or the Medicare option, have offered a different kind of service, a different level of service with much higher premiums, with much higher basically insurance, but also higher charges for themselves. So then you have a very differentiated system in the end in terms of service. What do you think?

JACQUELINE LUQMAN: I mean truthfully, that’s exactly what we have right now even if you are an employee and you receive your insurance through an employer. You select your plan, if you have a choice of plans based on how much you can afford to pay out of pocket for each plan. And there are different levels for these plans. This is for people who have full-time jobs, who have full-time employee benefits, who get a choice in, allegedly, of what kind of insurance they can select. So if you’re a single person, you can choose the least out of pocket, the plan that gives you the least amount of coverage or the basic coverage for the least out of pocket expense for you.

But what if you have a family or what if you have some health issues or you just want more to be covered in your plan, then you would opt to pay for a higher level of coverage. You know, it’s the basic, it’s the gold, it’s the platinum level of health insurance plans. We already have that among one class of insured people and that’s full-time employed people. But then there are people who are not full-time employees, who are part-time employees, or who are unemployed and they’re on a different type of insurance or they have access to a different type of insurance. So we already have a class stratified health care coverage system in this country. Medicare for All really does seem to address that.

So the idea, I think, and this is the problem I had with what Pete Buttigieg said, that Sanders doesn’t seem to trust the American people to choose, but if we’re not giving American people an actual choice in whether they’re going to be fully covered or whether they have to worry about if they can afford decent healthcare coverage, how can the American people trust any of them with providing what’s supposed to be a choice or not? And I think it’s clear that Americans don’t.

GREG WILPERT: Another issue that hasn’t come up in this particular debate, but that’s very closely related and came up I think in a previous one, which is the issue of whether or not non-citizens, particularly undocumented immigrants, should be covered. And that gets to the issue – a human rights issue, right? And so I wanted to ask you, Helena, what do you think of the fact that this has been left out and you’re a human rights lawyer?

HELENA OLEA: Well, I think that we should also underscore the point that it’s incredibly positive and this is a great evolution in the United States that we are having a discussion about the right to health, that health care is a top element in the discussion of the presidential debate is an important gain. As of today, most Americans are even skeptical of the concept of the right to health. They still believe that it’s a service that you purchase in the market, so we are moving ahead and I think that that’s very important.

And I did miss from the discussion any mention whatsoever about ensuring access to healthcare for undocumented persons in the US and it’s interesting. I was wondering whether this was done on purpose, whether those who raised the point very strongly in the last debate decided that perhaps this was not going very well, and so they decided to retreat a little bit in this point, but we have the videos. It’s documented there, so we’ll see whether we observe it again. I’m sure the Republicans are going to try to throw it back at the Democrats as we move ahead in the election process.

GREG WILPERT: So we’re going to conclude our first segment here on the third Democratic presidential debate. I urge everyone to join us for the next segment where we’ll take up more on the issue of immigration, but also inequality and racism. Thanks for joining us here at The Real News Network.