The first order of business? Debating Medicare for All, the plan popularised by Vermont Sen. Bernie Sanders which would transition everyone in the United States to a single government-run health insurance plan like the UK's NHS, as opposed to allowing people to keep their private insurance while also allowing for a public option.
The idea of Medicare for All has been polarising, to say the least. Dozens of countries have "universal healthcare" systems, which is essentially what Medicare for All would help create. While the idea was on the political fringes as recently as the 2016 presidential election, now nearly half of the Democratic presidential hopefuls support Medicare for All or plans that come close, but have limitations.
On the debate stage on Tuesday, Sanders and Massachusetts Sen. Elizabeth Warren presented a united front as the two candidates who are all in for Medicare for All. Sanders' plan is the most aggressive of the bunch, calling for the elimination of private insurances and a transition into a single-payer system within four years. Warren, on the other hand, supports eliminating private insurance, but has also said that in the meantime it's necessary for lawmakers to expand who gets access to free or cheap health coverage.
CNN's Jake Tapper, one of the debate moderators, asked Sanders whether the benefits Americans would receive under the single-payer system would be as good as those union workers have negotiated over. "They will be better because Medicare for All is comprehensive and covers all healthcare needs for senior citizens. It will finally include dental care, hearing aids, and eyeglasses," Sanders said, before being interrupted by Ohio Rep. Tim Ryan, who said: "You don’t know that, Bernie." The Vermont senator shot back: "I do know. I wrote the damn bill."
Candidates such as Ryan, former Texas Rep. Beto O'Rourke, Minnesota Sen. Amy Klobuchar, Maryland Rep. John Delaney, and Montana Gov. Steve Bullock have taken a more centrist approach to fixing the healthcare system. Some candidates support a so-called public option, which would add a government-backed insurance plan to compete with private plans and potentially allow more Americans to buy into the Medicare program. (Right now, there are about 28.5 million people who are uninsured.)
But at the heart of the debate is a fundamental disagreement over what's possible. By eliminating private insurance, Sanders and Warren want to remove the "business" aspect of the system. "These insurance companies do not have a God-given right to make $23 billion in profits and suck it out of our healthcare system," Warren argued. But moderates don’t think that approach is doable because the private insurance industry is a crucial component of the healthcare system itself.
Warren said that the entire cohort of Democrats want to make healthcare more accessible for Americans, unlike "Republicans" — taking a clear dig at how the GOP-controlled Congress and the Trump administration attempted to repeal the Affordable Care Act, commonly known as Obamacare, in 2017.
But she was also frustrated at candidates such as Delaney questioning the idea of a single-payer system. "I don’t understand why anybody goes to all the trouble of running for president of the United States," she said, "just to talk about what we really can’t do and shouldn’t fight for."