The Democratic primary debate Wednesday night revealed two big things when it comes to health care.

First, most candidates on the stage were not interested in abolishing private health insurance in favor of a government-run plan, which is at the core of Medicare for All.

Second, none of the Democrats had a good answer on how to pass Medicare for All or any proposal that expands the role of government-run insurance, so long as Republicans maintain control of the Senate.

Democrats’ answers to two questions really illuminated this: Who here would abolish their private health insurance in favor of a government run plan? And do you have a plan to deal with Senate Majority Leader Mitch McConnell (R-KY) if you don’t beat him in the Senate? 


Of the ten candidates running to unseat President Donald Trump, only two — Sen. Elizabeth Warren (MA) and New York City Mayor Bill de Blasio — raised their hands in favor of abolishing private insurance.

“Look at the business model of an insurance company. It’s to bring in as many dollars as they can with premiums and pay out as few as possible for your health care,” said Warren. “That leaves families with rising premiums, rising co-pays and fighting with insurance companies to try get the health care that their doctors say they and their children need. Medicare for all solves that problem.” 

Recent polls show the public doesn’t really understand Medicare for All, and politicians haven’t made it any easier. Some define Medicare for All as something other than single payer. But ask any Medicare-for-All activist, and they’d tell you private insurance doesn’t have a significant role in the new health system.

UNITED STATES - JULY 19: Progressive Democrats of America holds a news conference to announce the launch of a Medicare for All Caucus at the Capitol on Thursday, July 19, 2018. (Photo By Bill Clark/CQ Roll Call) Single-payer activists say you need to take a closer look at polls on Medicare for All

Those who didn’t support single-payer health care made it clear they support some kind of public option, allowing Americans to voluntarily buy into the existing Medicare or Medicaid program.


“I am just simply concerned about kicking half of America off of their health insurance in four years,” said Sen. Amy Klobuchar (MN), referring to the transition period in Sen. Bernie Sanders’ (I-VT) Medicare for All bill, which Warren has also cosponsored.

When former Texas Rep. Beto O’Rourke echoed Klobuchar, de Blasio called him out on it.

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

“For those for whom it is working, they can choose Medicare,” said O’Rourke, likely referring to what’s instead known as “Medicare for America.”

Medicare for America would move everyone but people with employer-based insurance into a public plan. Over time, the hope is to have everyone covered by the government insurance. That’s different than Medicare for All, which requires everyone — including undocumented immigrants — who gets health care through work to get it through the government after four years. 

The debate cleared up a lot of confusion on candidates’ stances on Medicare for All. Before Wednesday, the only candidate to unequivocally and vocally support Medicare for All was Sanders.


Still, regardless of where the candidates stood, none of them explained how they’d make health care reform possible if Republicans keep the Senate. Even if Democrats take back the White House, it’s likely the GOP holds the Senate — especially given the fact that a few Democrats who could flip Senate seats decided to run for president instead.

Republicans would also likely be against every health care idea Democrats floated during Wednesday night’s debate, as they are in favor of the private market controlling health care. Even Senate Republicans who have historically worked better with Democrats wouldn’t entertain including moderate Obamacare reforms in a recent bipartisan health bill, calling it too polarizing.

And it’s not just conservative lawmakers. The health industry is also against Medicare for All and public option proposals. A coalition of leading industry groups called the Partnership for America’s Health Care Future are working to defeat any legislation that doesn’t center around shoring up the Affordable Care Act.

Democrats had the opportunity to talk about this political reality — that ambitious policies are as good as dead if they don’t address the Senate.

“You have a lot of ambitious plans,” NBC journalist and debate moderator Chuck Todd told Warren, referring to the candidate’s policy proposals thus far. “Do you have a plan to deal with Mitch McConnell if you don’t beat him in the Senate, if he’s sitting there as Senate majority leader? It’s very plausible you’d be elected president with a Republican Senate. Do you have a plan to deal with Mitch McConnell?” 

“I do,” Warren said, to applause from the audience. “Short of a Democratic majority, you better understand the fight still goes on. It starts in the White House and it means that everyone we energize in 2020 stays on the front lines come January 2021.”

Former Rep. John Delaney (MD), alternatively, said Democrats “need to operate in a bipartisan manner.”    

Other Democrats used the time to discuss their record of bipartisanship, instead of debating the right political strategy.

“As my colleagues know, I fought from the day I got to the Senate and built coalitions and passed the First Step Act,” said Sen. Cory Booker (NJ). “Not as far as I want to go, but thousands of people will be liberated.”

None of these answers are real plans for how to get bold policy plans passed in Congress. As Vox’s Ezra Klein wrote, the candidates should be talking not just about the presidency, but about how to win back Congress as well.

“They’d release detailed plans for organizing in purple states and crafting a message designed to carry coattails. They’d be discussing statehood for Puerto Rico and DC — which is both the right thing to do on the merits and would strengthen Democrats’ Senate competitiveness in the future. It’d be all hands on deck to take back the Senate.”

Washington Gov. Jay Inslee did suggest abolishing the filibuster before answering a question about climate change. That political procedure has been a major roadblock in passing legislation, as it allows debate to continue so long as any one senator can get on the floor and talk. But that was the only concrete idea mentioned, and it wasn’t debated. (Warren and O’Rourke also support abolishing the filibuster, though neither of them mentioned it in Wednesday’s debate.)

Next time, it might be helpful if the candidates debate abolishing the filibuster and other strategies that could help them pursue their bold ideas.

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