A Decent Health Care System Was the Big Loser in Last Night’s Debate

Americans want a universal public health plan, but the idea has no champion in this presidential election. Instead, we have Donald Trump’s scorched-earth campaign against the ACA, and Joe Biden moving further and further away from even a universally available public option.

US president Donald Trump and Democratic presidential nominee Joe Biden participate in the final presidential debate at Belmont University on October 22, 2020 in Nashville, Tennessee. (Chip Somodevilla / Getty Images)

Most coverage of last night’s debate is understandably focused on which of the two candidates performed better and what that means for a potential Donald Trump second term or Joe Biden presidency. It’s also worth dwelling on the prospects for another main character in American politics: Medicare for All, or a single-payer health care system, popularized by Bernie Sanders in his first and second presidential campaigns.

Polling from last week shows that a majority of Americans want Medicare for All — little wonder, since the pandemic has also been accompanied by mass unemployment, causing millions to lose employer-sponsored private health care coverage in the middle of a public health emergency and underscoring the dysfunctionality of the system — but you wouldn’t know it from last night’s debate. Trump scaremongered about socialized medicine, but there was nothing like socialized medicine on the table.

When the conversation turned to health care, Trump alleged on five occasions that Biden wanted to enact socialized medicine. At times, he seemed to accuse Biden of covertly supporting Medicare for All, while at other times, he seemed to suggest that Biden’s moderate plan to expand on the Affordable Care Act (ACA) was itself socialist in nature. In both cases, the message was the same: if Biden wins, he will socialize the American health care system, “and this whole country will come down.”

For his part, Biden made it perfectly clear that he doesn’t plan to socialize even a part of the health care system. He distanced himself from Bernie Sanders and Medicare for All, quipping that Trump “thinks he’s running against someone else. He’s running against Joe Biden. I beat all those other people because I disagreed with them.” As to the matter of the disagreement, Biden clarified that “the reason why I had such a fight for, with twenty candidates for the nomination, was I support private insurance.” Biden also reiterated repeatedly that he was for “affordable health care,” not a tax-funded insurance plan that renders health care free at the point of service, which is the bare minimum required for something to even be distantly compared to real socialized medicine.

But Biden’s conservative response to Trump’s ridiculous red-baiting over health care didn’t stop at his strenuous disavowal of the remarkably popular Medicare for All policy idea. He also seemed, confusingly, to suggest that his proposed public option was not universal. The health care plan on Biden’s website stipulates that “all Americans will have a new, more affordable option,” suggesting the creation of an optional public health insurance plan that would be universally available. However, that’s not how Biden described it on the debate stage.

When prompted by the moderator to lay out his health care plan, Biden delivered a prepared three-part response. The first part concerned the public option. Here are his comments on the public option in full:

What I’m going to do is pass Obamacare with a public option — become Bidencare. Public option is an option that says that if you, in fact, do not have the wherewithal to be — if you qualify for Medicaid, and you do not have the wherewithal in your state to get Medicaid, you automatically are enrolled, providing competition for insurance companies. That’s what’s going to happen.

To hear Biden tell it during the debate, the public option he’s proposing is not a public option at all. Instead, it’s an initiative to automatically enroll people who qualify for Medicaid under the ACA but live in states that didn’t take the Medicaid expansion into some kind of free health insurance program. This is also mentioned on his website, and it’s a necessary corrective if you don’t plan to implement Medicare for All — but it’s not the extent of the plan. His website suggests that anybody will be able to buy into a public option if they so choose, but his comments during the debate suggested no such thing.

It’s unclear if Biden simply made a mistake by fixating on a narrow aspect to the exclusion of the rest of his public option plan, or if he was consciously walking back his stated support for a public option that’s available for all Americans to buy into. Some support for the latter interpretation is provided by the fact that Biden said something similar, in fact even more pointed, during the first presidential debate in late September:

It’s only for those people who are so poor they qualify for Medicaid they can get that free in most states, except governors who want to deny people who are poor Medicaid. Anyone who qualifies for Medicaid would automatically be enrolled in the public option. The vast majority of the American people would still not be in that option.

Perhaps Biden meant to add, “unless they want to be.” Either way, he’s clearly not keen to play up the idea of a universally available public option on the campaign trail. And if he’s not promoting it now, that doesn’t bode well for his plans to pursue it in office, should he defeat Donald Trump.

Trump, for his part, is still hell-bent on destroying the ACA without a replacement plan, and on accusing any alternative to his scorched-earth campaign of socialist tendencies. These two poles represented by Trump and Biden are shifted significantly to the right of popular opinion. Americans want Medicare for All, but Medicare for All has no champion in this presidential election — far from it. It’s an idea whose day will certainly come, but given our options, today is not that day.