Single payer in the Democratic debate

Transcript of the Democratic Presidential Debate in Miami

The New York Times, March 10, 2016


HILLARY CLINTON: But let me say this. Senator Sanders has talked about free college for everybody. He’s talked about universal, single payer health care for everybody. And yet, when you ask questions, as many of us have and more importantly, independent experts, it’s very hard to get answers.

And a lot of the answers say that this is going to be much more expensive than anything Senator Sanders is admitting to. This is going to increase the federal government dramatically. And, you know, my dad used to say, if it sounds too good to be true, it probably is.

BERNIE SANDERS: All right. Let me respond to this.


CLINTON: And we deserve answers about how these programs will actually work and how they would be paid for.

SANDERS: I want you all to think. What Secretary Clinton is saying is that the United States should continue to be the only major country on earth that doesn’t guarantee health care to all of our people.


SANDERS: I think if the rest of the world can do it, we can. And by the way, not only are we being ripped off by the drug companies, we are spending far, far more per capita on health care than any other major country on earth.

You may not think the American people are prepared to stand up to the insurance companies or the drug companies. I think they are. And I think we can pass...

RAMOS: Thank you senator. (CROSSTALK)


CLINTON: This is a very important point in this debate, because I do believe in universal coverage. Remember, I fought for it 25 years ago. I believe in it. And I know that thanks the Affordable Care Act, we are now 90 percent of universal coverage. I will build on the Affordable Care Act. I will take it further. I will reduce the cost.

But I just respectfully disagree. Between the Republicans trying to repeal the first chance we’ve ever had to get to universal health care, and Senator Sanders wanting to throw us into a contentious debate over single-payer, I think the smart approach is build on and protect the Affordable Care Act. Make it work. Reduce the cost.


SANDERS: I’m on the committee, I know a little bit about this, I’m on the committee, Health, Education, Labor Committee that helped write the Affordable Care Act. And it has done a number of good things. But when Secretary Clinton says, well, 90 percent of the people have insurance, yes, not really.

Many of you may have insurance, but you have outrageously high deductibles and co-payments. One out of five Americans cannot afford the prescription drugs their doctors prescribe. Elderly people are cutting their pills in half.

I do believe that we should do what every other major country on earth does, and I think when the American people stand up and fight back, yes, we can have it, a Medicare for all health care system.



Hillary Clinton’s health care proposals:

Bernie Sanders’ health care proposals:

Donald Trump’s health care proposals:



By Don McCanne, M.D.

Although today’s message does not seem appropriate for this forum since it is political and our agenda is on policy, actually it is apropos since it represents a disagreement over single payer policy, even though framed as a political debate.

Of the three candidates for the presidential nomination who have mentioned single payer, Donald Trump has recently clarified his stance by releasing a health reform proposal that made no mention of single payer. So the debate over single payer is really between the two remaining Democratic candidates - Hillary Clinton and Bernie Sanders.

In this election season, single payer is a political issue. Bernie Sanders is the first leading presidential candidate to support a bona fide single payer Medicare for all. Hillary Clinton continues to support private health plans in a multi-payer system, originally as her managed competition model 25 years ago, and now as incremental expansion of the Affordable Care Act. She opposes single payer since it would eliminate the private insurers.

The politics have been somewhat bizarre. The Republicans have not had to take a high profile position against single payer since many in the progressive community have done their work for them. Although often presented as policy arguments, the substance of the opposing arguments by these progressives has been political. We can only speculate that their reasons have more to do with their support of a particular political candidate than they do with their position on single payer. In fact, the leading analysis being used to oppose single payer was written by an academic who has authored other single payer proposals. Fortunately, many others in the progressive community have stood up to insist that single payer be accurately portrayed.

Instead of trying to wade through the proxy arguments of these outside experts, it would be better to listen to the words of the two candidates themselves. What did they have to say in last night’s debate?

Sanders reiterated his views on a truly universal Medicare for all, whereas Clinton reiterated her views on rejecting single payer and building on the Affordable Care Act which she mentions has us at 90 percent coverage. These are policy issues.

When you look at their respective plans (links above), you can see that, from a policy perspective, Sanders’ proposal automatically covers everyone, whereas Clinton’s proposals barely nudge us in that direction but cannot come close to universal coverage. In addition, Sanders points out that the current private insurance products frequently do not meet the needs of those insured because of the exposure to high out-of-pocket costs. Again, regardless of the politics, these are fundamental policy issues that often determine whether or not people will receive the health care that they need.

We’ll continue to speak out on policy and leave it to others to get the politics right.

Physicians for a National Health Program (PNHP) is a nonpartisan educational organization. It neither supports nor opposes any candidates for public office.