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Dem Debate: “Disingenuous” Attacks on Medicare for All Distract from Cost of Today’s Broken System

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Image Credit: CNN

Democratic candidates sparred at Tuesday’s debate over their healthcare platforms and Medicare for All. We speak with Dr. Steffie Woolhandler, a professor at CUNY-Hunter College and the co-founder of Physicians for a National Health Program. Moderators in the CNN and New York Times debate repeatedly pressed Elizabeth Warren on whether taxes would increase under Medicare for All. “The framing of that question is crazy,” says Dr. Woolhandler. “What really matters is how much a household is paying.”

This is a rush transcript. Copy may not be in its final form.

AMY GOODMAN: This is Democracy Now! I’m Amy Goodman, with Juan González.

JUAN GONZÁLEZ: As we continue to look at last night’s Democratic debate, we turn now to the issue of healthcare. This is South Bend Mayor Pete Buttigieg speaking last night.

MAYOR PETE BUTTIGIEG: I don’t think the American people are wrong when they say that what they want is a choice. And the choice of Medicare for All who want it, which is affordable for everyone because we make sure that the subsidies are in place, allows you to get that healthcare. It’s just better than Medicare for All, whether you want it or not. And I don’t understand why you believe the only way to deliver affordable coverage to everybody is to obliterate private plans, kicking 150 million Americans off of their insurance in four short years, when we could achieve that same big, bold goal — and, once again, we have a president — we’re competing to be president for the day after Trump. Our country will be horrifyingly polarized, even more than now. After everything we’ve been through, after everything we are about to go through, this country will be even more divided. Why unnecessarily divide this country over healthcare when there’s a better way to deliver coverage for all?

MARC LACEY: Thank you, Mayor. Senator Sanders?

SEN. ELIZABETH WARREN: I’d like to be able to respond to this.


SEN. BERNIE SANDERS: Well, as somebody who wrote the damn bill, as I said, let’s be clear. Under the Medicare for All bill that I wrote, premiums are gone, copayments are gone, deductibles are gone, all out-of-pocket expenses are gone. We’re going to do better than the Canadians do, and that is what they have managed to do. At the end of the day, the overwhelming majority of people will save money on their healthcare bills. But I do think it is appropriate to acknowledge that taxes will go up. They’re going to go up significantly for the wealthy. And for virtually everybody, the tax increase they pay will be substantially less — substantially less than what they were paying for premiums and out-of-pocket expenses.

MAYOR PETE BUTTIGIEG: Well, at least that’s a straightforward answer. But there’s a better way.

MARC LACEY: Senator — Senator Warren, will you acknowledge what the senator just said about taxes going up?

SEN. ELIZABETH WARREN: So, my view on this, and what I have committed to, is costs will go down for hard-working, middle-class families. I will not embrace a plan like Medicare for All who can afford it, that will leave behind millions of people who cannot. And I will not embrace a plan that says people have great insurance, right up until you get the diagnosis and the insurance company says, “Sorry, we’re not covering your expensive cancer treatments. We’re not covering your expensive treatments for MS.”

MARC LACEY: Thank you, Senator.

SEN. ELIZABETH WARREN: “We’re not covering what you need.”

MARC LACEY: Senator Klobuchar?

SEN. ELIZABETH WARREN: I didn’t spend most of my time in Washington. I spent most of my time studying one basic question, and that is why hard-working people go broke. And one of the principal reasons for that is the cost of healthcare. And back when I was studying it, two out of every three families that ended up in bankruptcy after a serious medical problem had health insurance. The problem we’ve got right now is the overall cost of healthcare. And, look, you can try to spin this any way you want. I’ve spent my entire life on working on how America’s middle class has been hollowed out and how we fight back. I’ve put out nearly 50 plans on how we can fight back and how we can rebuild an America that works. And a part is that is we’ve got to stop —

MARC LACEY: Thank you, Senator.

SEN. ELIZABETH WARREN: — Americans from going bankrupt over healthcare costs.

JUAN GONZÁLEZ: That was Senator Elizabeth Warren talking about Medicare for All. The questioner was The New York Times national editor Marc Lacey. Steffie Woolhandler, your response? And the refusal of Elizabeth Warren to be pigeonholed by the question as to whether taxes would be raised?

DR. STEFFIE WOOLHANDLER: OK, well, I think the framing of that question is crazy. What really matters is how much a household is paying. And as Senator Sanders said, you’re going to be paying so much less in premiums, copays and deductibles that you’re going to be paying less total for healthcare than you are today. Right? You’re going to be paying a little bit more taxes, but you’re going to be paying less of those premiums and copays and deductibles. But, overall, you’re going to be better off financially. That’s the correct framing. And to sit around and obsess about whether you pay that $3,000 as a tax or that $3,000 as a premium is the wrong framing. And that’s really what Senator Warren was rejecting, in my opinion.

AMY GOODMAN: And that’s how the media always frames it, the corporate media.

DR. STEFFIE WOOLHANDLER: The corporate media is always framing it. And, you know —

AMY GOODMAN: But stops about every five or six or seven minutes for a drug commercial.

DR. STEFFIE WOOLHANDLER: Yeah, that’s for sure. And, you know, it’s quite disingenuous, because the Pete Buttigieges and the health policy analysts of the world do understand that. They do know that people in other nations with single-payer Medicare for All pay a lot less for their healthcare than people do in the United States. But they use that little trick about talking about taxes as something horrible, but premiums, copays and deductibles as something good. They use that trick to fool people.

JUAN GONZÁLEZ: And is it clear what Buttigieg means by Medicare for those who want it?


JUAN GONZÁLEZ: Medicare for All for those who want it?

DR. STEFFIE WOOLHANDLER: Yes. It seems like he’s endorsing a plan that goes by many names — Medicare Part E, Medicare Extra for All — which would involve large subsidies for people to purchase a Medicare-like plan if they wanted it, but people in private insurance, because their employer purchased it, could stay in the private insurance. The problem with that is it’s much more expensive than Medicare for All, because if you include private insurance, you’re also including their massive overhead and profits, which average 12% of total premiums, often more. You’re continuing to waste hundreds of billions of dollars every year in the excess administrative costs at doctor’s offices and hospitals, because doctors and hospitals have to deal with multiple insurers.

The whole idea of single-payer Medicare for All is you have a simple payment system. You can shrink that huge bureaucracy, health bureaucracy, save about $500 billion a year by shrinking that bureaucracy. And that $500 billion is the money you need to cover everyone and eliminate copayments and deductibles. And Buttigieg is saying, “Oh, we can have our cake and eat it, too. We could have private insurance. We can have their hundreds of billions of dollars of wasteful bureaucracy and overhead, and we’re still going to be able to afford Medicare for All.” That’s simply not true.

AMY GOODMAN: Dr. Steffie Woolhandler, you were a big supporter of Bernie Sanders before now. You were also a close ally of Elizabeth Warren. You were both professors at Harvard. She did use the term “Medicare for All who can afford it.” What does she mean?

DR. STEFFIE WOOLHANDLER: Well, she was making fun of Buttigieg’s proposal, because the Medicare Extra plan, which I think he’s talking about, requires people to make — continue to pay substantial premiums, copayments and deductibles, even though they’d get some subsidies. So, she’s just saying — and I think it’s a correct point — that with this Medicare Extra for All, it’s so expensive, there’s so much administrative waste, that we’re going to get less coverage at a higher cost than what we could get with Medicare for All.

AMY GOODMAN: And if you could quickly comment, as a medical doctor, on Bernie Sanders’ heart attack? I mean, people were commenting — I mean, he looks so much better in this debate than the last one. He seemed like he had the flu in the last one but wasn’t actually admitting it. That’s obviously separate completely from a heart attack.

DR. STEFFIE WOOLHANDLER: Uh-huh. Well, you know, heart disease is not the death sentence it once was. Millions of people have heart attacks.

AMY GOODMAN: Cheney had like six of them.

DR. STEFFIE WOOLHANDLER: Yeah. And, you know, many of them are walking down the street, 7th Avenue. You know, we probably passed several of them on the way here to the studio. Some people get very sick immediately from their first heart attack. Some people have a very mild heart attack and go on for years and decades working hard and able to function. And, fairly obviously, Senator Sanders was very well able to function last night. And to say that all of those millions of people with heart disease are disqualified from participation in politics is just discriminatory and unnecessary.

AMY GOODMAN: We’re going to go to break and then come back. We’re talking about the fourth round of Democratic presidential primary debates. It took place last night in Ohio. There were 12 candidates. Tom Steyer, the billionaire, was added to the mix. Stay with us.

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