Health care is the number one issue on the minds of Democratic voters: Nearly 9 in 10 of them saying they want the topic discussed during the presidential candidate debates. Indeed, all candidates vying for the Democratic nomination seem to agree that everyone should have health care coverage, marking a huge step forward. After all, not long ago advocating for “universal” coverage was highly sensitive political territory.

But many candidates have been vague and noncommittal about how, exactly, they want to reform our health care system. Voters deserve the opportunity to understand the real, significant differences between each candidate’s approach to this critical issue.

As voters watch the debates this week, they should pay close attention to the candidates’ answers (and non-answers) to these three key questions.


If you are in favor of “Medicare for All,” what exactly does that mean? It may mean that everybody has health insurance, and the government pays for it through taxes. That sounds straightforward enough, but there are key nuances voters should listen for. Under Medicare today, virtually every service is covered — even those that are extremely expensive, such as cancer drugs. It’s easy enough to say that everything will be covered for everyone in the country. But for candidates taking that approach, the cost of Medicare for All would be astronomical. Candidates advocating for that policy need to explain to the public just how much health care would be covered and what services they’d consider rationing. Saying that we have a few years to figure it all out won’t cut it.

Will private insurance be allowed in a reform plan? There are differences among candidates about whether they want true “single-payer” coverage in the United States. Under such a plan, government — and the government alone — pays for health care; insurance would be permitted only for peripheral services such as cosmetic surgery. Some say this dramatic shift is the only way to fix our broken health care system. But others question whether it makes sense to prohibit individuals and businesses from paying for private insurance. This is a nuanced — albeit critically important — distinction. Candidates owe voters a clear explanation of their positions.

Those who favor a public version of insurance could propose several different options. One might be a government-sponsored insurance plan known as a “public option” that competes with private insurance and exists within the structure of the Affordable Care Act. Another version of Medicare for All allows individuals and businesses to opt out of the public program and simply pay for their own insurance. Still a third option could be a “single safety net,” in which everyone pays for health care, and everyone has access to a basic level of government sponsored health insurance, with the option of buying more.

How will we (yes, “we”) pay for any of these changes? Let’s get one myth out of the way: Extending insurance to the uninsured is more expensive than the status quo. Keeping people healthy is no doubt the right thing to do, but it costs money. In previous elections, we’ve seen candidates repeat the myth that preventive care saves money, so health care can be extended to those individuals at no cost. Research shows that, in the majority of cases, preventive care does not save money.

So here’s the hard part: Candidates who are serious about Medicare for All (or some other version of universal coverage) must clearly articulate not only the benefits of such a program but exactly how they’ll pay for it. As candidates discuss their health plans, voters should expect them to be specific about who will be taxed in order to pay for their plans and how they will make their case to Congress and the public.

Presidential candidates owe it to us to be as specific and transparent as possible in answering questions about the future of health care and other questions like them. It’s their job to put together the policy proposals they believe will work best for our country. And as informed voters, it’s our job to make sure we’re asking the right questions.

Arthur “Tim” Garson Jr., M.D., is director of the Texas Medical Center Health Policy Institute in Houston and a past president of the American College of Cardiology. Ryan Holeywell is director of communications at the Texas Medical Center. They are co-authors of “Exposing the Twenty Medical Myths: Why Everything You Know about Health Care Is Wrong and How to Make It Right” (Rowman & Littlefield Publishers, September 2019).

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