Candidates clash over Medicare for All in Thursday's debate

Former vice president Joe Biden pitted his $740 billion public option against his opponents' $30 trillion over 10 years Medicare for All plan in last night's Democratic debate in Houston.

While the stage held 10 Democratic candidates, the first half hour was devoted to healthcare and the differences between Biden and challengers Senators Bernie Sanders and Elizabeth Warren, who both want to replace Obamacare with Sanders' Medicare for All plan.

"The Senator says she's for Bernie, well I'm for Barack," Biden said. "I think the Obamacare worked. I think, we add to it, replace everything that's been cut, add a public option, guarantee that everyone will be able to have affordable insurance, number one," Biden said. "Number two, I think we should be in a position of taking a look at what costs are. My plan for healthcare costs a lot of money, it costs $740 billion dollars. It doesn't cost $30 trillion dollars, $3.4 trillion a year, it turns out, it's twice what the federal budget is."

Sanders told Biden the cost would actually be $50 trillion over 10 years.

"Every study done shows that Medicare for All is the most cost effective approach to providing healthcare to every man, woman and child in this country," Sanders said. "I who wrote the damn bill, if I may say so, intend to eliminate all out-of-pocket expenses, all deductibles, all copayments. Nobody in American will pay more than $200 dollars a year for prescription drugs because we're going to stand up to the greed and corruption and price fixing of the pharmaceutical industry."

Warren said the country owes a huge debt to President Barack Obama, who "fundamentally transformed healthcare in America."

"And now the question is, how best can we improve on it?" she said. "And I believe the best way we can do that, is we make sure that everyone gets covered by healthcare at the lowest possible cost. How do we pay for it? We pay for it, those at the very top, the richest individuals and the biggest corporations are going to pay more and middle class families are going to pay less. That's how this is how this is going to work."

WHY THIS MATTERS

Medicare for All has become one of the biggest issues going into the 2020 presidential election, at least for Democrats.

Both providers and payers are against it. Insurers are understandably against a plan that would eliminate private insurance. Providers say a government-run health plan would ultimately result in lower reimbursement.

Medicare pays at a lower rate than private insurance, with hospitals that heavily rely on government payments struggling to break even. Rural hospitals are already at risk of closing from receiving more of their payments from lower reimbursement rates.

Also, half of consumers may be confused about a Medicare for All plan. Fifty percent who answered a recent Eligibility survey found that they believed Medicare coverage is free. Sanders' plan would cap premiums at about 9.5 percent of household income.

Biden supports a public option such as Medicare for those who choose the coverage, offering premium-free access only for those people who would otherwise qualify for Medicaid, but live in states that have not expanded Medicaid under the Affordable Care Act.

THE LARGER TREND

Democrats will rally behind the Democratic primary winner and presumably his or her plan for healthcare, in a united effort to beat President Trump in 2020.

The larger picture is that as the Democrats have been talking about universal coverage, the government, through the Centers for Medicare and Medicaid Services, has been heading in the opposite direction promoting value-based care under both Democrati and Repubican administrations. Traditional Medicare is fee-for-service.

At least a third of all Medicare beneficiaries have a Medicare Advantage plan, which is based on a capitated payment per beneficiary. The number of MA members stands at about a third of all those who qualify for Medicare, and that percentage is expected to grow.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com