Senator Bernie Sanders Inarguing his case for Medicare for All in the latest debates, Sen.Bernie Sanders noted that over the next decade, the nation isprojected to end up spending more than $50 trillion on healthcare.

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Democratic presidential candidates faced off on the debate stagefor the eighth time this campaign season. Meeting in Manchester,N.H., they returned to now familiar health care themes — "Medicare for All" versus a public option, thecost of prescription drugs and other key areasthey say are ripe for change.

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Once again, candidates sparred over the cost of the single-payerhealth reform bill promoted by Vermont  Sen. BernieSanders. Former Vice President Joe Biden argued it wouldnecessarily raise taxes, pointing to its estimated $32 trillionprice-tag (a number supported by independent economist estimates). Sanders noted that over thenext decade, the nation is projected to end up spending more than$50 trillion on health care. (That's also borne out by evidence.)

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Related: Americans support more government action on healthcare

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Sen. Elizabeth Warren of Massachusetts and Sen. Amy Klobuchar ofMinnesota also dove into issues related to abortion rights. Warrentouted the statistic that three out of four Americans believe thatRoe v. Wade should be the law. This is pretty accurate — a recentKaiser Family Foundation poll found that 69 percent of Americans do not want Roe v. Wadeoverturned. And Klobuchar again talked about how there isoverwhelming support for Planned Parenthood. We previously checked this claim.

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The candidates also discussed the opioid epidemic and the shortage of substanceabuse treatment beds — in New Hampshire and nationwide.

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Here are some highlights and related fact checks:

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Klobuchar and Buttigieg, the former mayor of South Bend, Ind.,sparred over his record of support for Medicare for All, thesingle-payer health care bill Sanders backs. Klobuchar noted thatButtigieg previously tweeted in favor of the bill and has sincechanged his position. Buttigieg said he has been consistent onsupporting an approach that would bring health care to allAmericans.

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Klobuchar's point — that Buttigieg has at least expressedsupport for the specific bill, and no longer does — is supported byevidence.

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The tweet was posted on Feb.18, 2018. Buttigieg wrote, "I, Pete Buttigieg, politician, dohenceforth and forthwith declare, most affirmatively andindubitably, unto the ages, that I do favor Medicare for All, as Ido favor any measure that would help get all Americanscovered."

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Since then, Buttigieg has narrowed his stance — backing"Medicare for all who want it," a plan he argues would also achieveuniversal coverage, by letting people opt into a public healthplan, and offering more generous subsidies for those who purchaseprivate insurance. (Proponents of single-payer are skeptical itwould succeed.)

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To be fair, even Buttigieg's 2018 statement includes animportant qualifier — he's not tied to the plan. He favors Medicarefor All, he says, as he does "any measure that would help get allAmericans covered." If you agree that his current plan would alsoachieve universal health care, there's an argument that he has beenconsistent.

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—Shefali Luthra

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This is in reference to Medicare for All. We contacted Biden'scampaign, who directed us to the 2018 federal budget — $4.1trillion — compared to the estimated $32 trillion price tag ofSanders' single-payer proposal. But there's a problem: That latternumber is an estimate of the cost for 10 years. So putting one yearof the budget against a decade of health spending is comparingapples and oranges.

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And converting one year's budget to a decade-long forecast is aneconomically complex proposition — it's not so simple as justmultiplying by 10.

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We also ran this claim by an independent expert, who crunchedthe $32 trillion estimate. Linda Blumberg, an institute fellow atthe Urban Institute, told us Biden's comparison is "anexaggeration" and "overstatement."

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Certainly, she said, Medicare for All would be "a biggerincrease to the federal budget than we've ever experienced" — morethan a 70 percent increase, compared to the CBO's 10-yearbudget estimate.

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"This is an enormous increase, but it wouldn't double" thebudget, she said.

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—Shefali Luthra

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This is a favorite talking point from Sanders. We double-checkedthe math during the last debate. It holds up — and is probably an underestimate.

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The figure is derived by adding the "net revenues" as reportedby the companies for 10 pharmaceutical companies and 10 companiesthat work in health insurance. Multiple independent economistsreviewed the methodology with, and affirmed that it's sound. Infact, the total "net revenue" — or profit — is actually around $101billion.

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The talking point doesn't include health care's biggest earners,though: hospitals and health systems. When you factor them in,experts previously told us, the level of profit in our system willgrow significantly larger.

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—Shefali Luthra

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The way Sanders uses this number is problematic andoversimplifies the research. When we previously fact-checked this claim, we rated it Half True.

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It appears that the number comes from Physicians for a NationalHealth Program, which cited the Oregon Health Insurance Experiment,a study that assigned by lottery some participants to Medicaid andthe others remained without insurance. A year into the experiment,researchers found that the death rate differed by 0.13 percentagepoints between those who were on Medicaid and those who were not —though this difference was not statistically significant. If youextrapolate this number to the number of Americans who areuninsured — about 27 million — then you do get close to a figure ofabout 30,000 people.

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However, experts said that since the difference was notstatistically significant it shouldn't be extrapolated so broadly,and it's possible that Sanders' number is too high. Other researchdoes show that there is a connection between being uninsured andhigher likelihood of mortality. Thousands of Americans die waitingfor health care every year, but this number relies on imprecisemath.

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—Victoria Knight

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This is true. If anything, it falls a little short.

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The data comes from an estimate by the  CommonwealthFund, a health care research and advocacy group. Researchers foundthat in 2018, 37 million non-elderly Americans — about 1 in 5people — skipped a prescription because they couldn't afford it.Some of those people had coverage. Others were "underinsured." Thatmeans they had insurance, but it wasn't enough to safeguard themfrom large medical bills.

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Other data suggests it's potentially even worse. A November pollfrom West Health and Gallup estimated that 58 million Americansexperienced what they called "medication insecurity" in the past 12months.

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—Shefali Luthra

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On the campaign trail, Warren has often mentioned that she woulduse the power of the executive office to reduce prescription drugprices for drugs such as HIV medication and EpiPens. We checked it,and it is true that the president has these executive powers.

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Warren has in her "Medicare for All" transition plan a pledgethat she would use two legal mechanisms to achieve this goal —"compulsory licensing" and march-in rights. Compulsory licensingmeans the government will take over a patent if a drug's prices aretoo high and create competition. There is precedent for thisapproach, it was done in the 1960s for cheap generic drugs and in2001 for Ciprofloxacin during the anthrax scare. Experts said thislikely couldn't be applied to all drugs but could work for insulinand EpiPens.

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March-in rights are when the government "marches in" during apublic health crisis because a drug isn't available. But, it onlyworks for drugs in which the government holds all of the patents,such as Truvada, the HIV prevention drug. However, this mechanismhas never been employed and it's unclear whether high prescriptiondrug prices would qualify as a public health concern. Officials atthe National Institutes of Health would also have to approve thismeasure, and it would face significant backlash from thepharmaceutical industry.

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Warren is right that the laws are in place for her to reduceprescription drug prices without the power of Congress, but it'slikely it would be difficult.

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—Victoria Knight

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Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

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