Medicare for All dominates debate; Sanders, Warren defend it against Biden
Sens. Bernie Sanders, left, and Elizabeth Warren, right, sparred with former Vice President Joe Biden, center, over many issues, but most intensely over the matter of Medicare for All. | AP photos

HOUSTON—Tussles over health care dominated the discussion as the ten leading Democratic presidential hopefuls debated each other before a boisterous crowd in Houston on Sept. 12.

The key disagreements were between Sens. Bernie Sanders, Ind.-Vt., and Elizabeth Warren, D-Mass., who championed single-payer government-run Medicare for All, and former Vice President Joe Biden. He vowed to improve the Affordable Care Act and questioned single-payer’s costs. Others pointed out that workers with good health care plans might not want to give them up.

The debate, at Texas Southern University, one of the nation’s historically black colleges, also touched on several issues important to students—college student debt and proposals for tuition-free college—African Americans, or both, such as criminal justice reform and environmental racism.

There were two key points all the Democrats agreed upon. One was the absolute need to defeat GOP incumbent Donald Trump next year. Recent polls show Trump with only a 38% positive rating and losing by seven percentage points nationwide to Warren, nine points to Sanders, and 16 points to Biden.

Denunciations of Trump were particularly sharp. “Houston, we have a problem,” Sen. Amy Klobuchar, DFL-Minn., deadpanned in her opening statement, using the line astronauts of the crippled Apollo 13 uttered years ago. “We have a guy who is running the country like a game show. He’d rather lie than lead.” Klobuchar later reminded the others Democrats must unite to defeat the Oval Office occupant.

Former Rep. Beto O’Rourke of Texas and California Sen. Kamala Harris were even tougher. O’Rourke said Trump “inspired” the mass murderer who gunned down 22 people, almost all of them Latino, in O’Rourke’s hometown, El Paso, several weeks ago. “One thing is clear: How dangerous Donald Trump is…I’m going to call out the fact that we have a white supremacist in the White House.” Harris said that even if Trump did not pull the trigger, he “tweeted out the ammunition.”

“President Trump, you have used hate, fear, intimidation and more than 12,000 lies to distract us from what you’re really doing,” Harris further declared. “The only reason you haven’t been indicted” for obstruction of justice “is because of a 20-year-old memo from the Justice Department,” she said, referring to a DOJ policy that sitting presidents cannot be indicted. “We’re going to give hope to America. And now, Donald Trump, you can go back to watching Fox News,” the president’s favored TV shills.

The other point of agreement was on the need to battle systemic institutionalized racism, which all said long predates Trump. “The question isn’t who’s a racist,” Sen. Cory Booker, D-N.J., said. “The question is who is or isn’t doing something about it.” If elected, Booker pledged to deal with systemic racism, including racial environmental justice.

South Bend, Ind., Mayor Pete Buttigieg touted his “Douglass Plan,” named for the great abolitionist leader Frederick Douglass, to pay reparations to descendants of enslaved Africans, and of directing 25% of federal contract money to firms owned and run by people of color.

“We also have to change attitudes, and not pit the displaced auto worker against the single Black mother of three, because many times, they’re the same person,” he said.

Once again in the nationwide telecasts, workers and their rights got short shrift. To be precise, only Warren uttered the word “union,” in the context of elevating public schools and their teachers. Nobody mentioned the economy, though Sanders again denounced the wealth and income gap between the 1% and the rest of us.

“I’m the only public school teacher on this stage,” as a special needs teacher before she became a college professor, Warren explained. “Money for public schools should stay in public schools,” not be sent to charter schools—a preferred policy of multimillionaire business owner Andrew Yang. And she’d strengthen public schools by raising teacher pay, enacting pre-K for all kids, “and strengthening our unions.”

The Democratic National Committee cut the field in half from earlier debates, each of which saw ten hopefuls on each of two days. In Houston, the top ten—Sanders, Biden, Warren, O’Rourke, Harris, Klobuchar, Booker, Buttigieg, Yang, and former San Antonio Mayor and HUD Secretary Julián Castro—were on stage at the same time.

The top three in polls, Biden, Warren, and Sanders, were in the middle. They were in the middle of the tussle over health care, too.

Biden touched it off by challenging Warren and Sanders on how they’d pay for Medicare for All. He prefers automatically offering Medicare enrollment to people who lose their jobs and their health care. Several other hopefuls touted a “public option” to introduce competition against the health insurers.

“We should be in the position of looking at what the costs are,” the ex-veep challenged the two senators. Medicare for All “is going to cost $3.4 trillion per year. I want to hear how they’re going to pay for it.” His plan, Biden claimed, would cost $740 billion yearly. He also would add a public option.

Left unsaid: One initial version of the Affordable Care Act back in 2009 let states adopt a public option, Medicare for All, or any other system that offered the same benefits as the ACA. Democratic President Barack Obama, Biden’s boss, didn’t lobby for that section or the public option, and it died.

Warren, Harris, and Booker thanked Obama for enacting the ACA and setting a goal—so far unrealized—of covering everybody. Warren then said she’d pay for Medicare for All as “those at the top, the very rich individuals and the giant corporations, will pay more and the middle class will pay less.”

“But families pay (now) every time they don’t get a prescription filled or they don’t have a lump checked out because they can’t afford it. Everybody loves their doctor. Nobody loves their insurance company. Medicare for All is instead of the insurance companies, which build their profits by saying ‘no’ and raising their premiums.”

Booker also supported Medicare for All, but claimed voters “are looking for solutions now.”

Later, Warren pointed out that Medicare for All and other progressive ideas, including more funding for public schools and criminal justice reform, have fallen victim to the corruption of moneyed special interests in Washington, her campaign’s theme. Combating those interests, Warren repeated during the second half of the three-hour discussion, would be a key feature of her White House tenure.

“I wrote the damn bill,” Sanders repeated about Medicare for All. “I’ve said (it) will cost $30 trillion over ten years. But keeping the status quo will cost $50 trillion.” The difference, he said, goes into the pockets of the big drug companies and the “greedy” and sometimes murderous health insurers.

“I intend to eliminate all out-of-pocket expenses, all deductibles, all co-pays, and nobody will pay more than $200 a year for prescription drugs because I’ll stand up to the greed and corruption and price-fixing of the pharmaceutical companies” by mandating how much the government, on behalf of customers, will pay for prescription drugs.

That won’t work, Biden claimed. Sanders reminded him that “We are spending twice as much per capita on health care as the Canadians or any other major country on Earth.” Biden smugly replied, “This is America.” His remark prompted Sanders to shoot back: “Yeah, but Americans don’t want to pay twice as much as other countries. And [other countries] guarantee health care to all people…. What people want is cost-effective health care.”

Klobuchar, Harris, and Buttigieg came down in the middle, offering, as Buttigieg put it, “Medicare for all who want it.” Sanders’s Medicare for All, the mayor bizarrely claimed, shows its backers “don’t trust the American people; I do.” Castro caught Biden backtracking on whether his plan would be free to the poorest, as Biden had said people could “buy in.” The former HUD Secretary said, “Your plan still leaves 10 million people uncovered.”

But Castro also was the only hopeful to make a linkage between the multitude of problems people face. Having grown up in a segregated neighborhood, Castro noted that housing segregation leads to bad health care outcomes for kids and school segregation leads eventually to the school-to-prison pipeline. They’re all linked, he explained.

From left, Sen. Amy Klobuchar, Sen. Cory Booker, South Bend Mayor Pete Buttigieg, Sen. Bernie Sanders, former Vice President Joe Biden, Sen. Elizabeth Warren, Sen. Kamala Harris, entrepreneur Andrew Yang, former Texas Rep. Beto O’Rourke and former Housing Secretary Julian Castro. | Eric Gay / Associated Press)

Yang blamed the current health care system for a worker rights problem: The proliferation of “independent contractors” unprotected by labor law, or almost anything else. Health care makes it cheaper for firms to misclassify workers as contractors, not employees, Yang said. Employees have worker rights, weak though they are, under federal law, but contractors do not.

Harris used her plan, with Medicare for All who want it, to remind viewers that the GOP tried to repeal the ACA and praised the late Sen. John McCain, R-Ariz., for defeating repeal. Since then, Harris noted, Trump and the GOP have been dismantling the ACA’s protections through administrative action. “His Justice Department is now trying to get rid of pre-existing condition coverage,” she said.

The joust also produced some new and notable comments. One was Biden apologizing for his vote to authorize President George W. Bush’s war in Iraq. He said he was misled. That prompted Sanders to remind the crowd he voted against all their wars “because I didn’t trust Bush and Cheney.”

Another was O’Rourke, in gun-happy Texas, saying he would push legislation to ban—and confiscate—assault weapons such as AR-15s and AK-47s. He said that even some Republican gun owners he spoke with in Conway, Ark., the day after El Paso, would give up their assault weapons to help make the nation safer.

And Yang, relying on his only shtick in this campaign, came up with another money giveaway—the presidential debate equivalent of a Publishers Clearinghouse Sweepstakes: “We have to see ourselves as the owners of democracy, and not cogs in machines. If you believe you can solve your own problems, go to and tell us how—and 10 families who win will get $1,000 a month.”


Mark Gruenberg
Mark Gruenberg

Award-winning journalist Mark Gruenberg is head of the Washington, D.C., bureau of People's World. He is also the editor of the union news service Press Associates Inc. (PAI). Known for his reporting skills, sharp wit, and voluminous knowledge of history, Mark is a compassionate interviewer but tough when going after big corporations and their billionaire owners.