Democratic candidates' health care attacks heat up

Joe Biden, Bernie Sanders and Elizabeth Warren

The ideal began to get real on Tuesday, as seven of the top contenders for the Democratic presidential nomination sparred over the price tag on health care reform and even revealed similarities on issues like marijuana legalization.

With Democrats in 15 states and American Samoa set to cast their primary votes in the next week, the candidates eagerly seized their chances on the debate stage in Charleston, South Carolina, to jab Sen. Bernie Sanders of Vermont, the current front-runner, during the party's 10th debate.

For all of their interruptions and talking over each other, though, the candidates offered a few thoughtful answers and, seemingly in spite of themselves, agreed on at least decriminalizing marijuana and expunging past, small-scale marijuana possession charges from Americans' criminal records.

Sanders said he would remove marijuana from the list of controlled substances on the first day of his presidency and added that he would empower black, Latino and Native American communities to start businesses selling the drug legally, rather than leave corporations to fill what is already a lucrative market.

Mike Bloomberg, the former mayor of New York City, expressed the most skepticism of full legalization because of his concerns about the drug's effect on the brains of young people. "Until we know the science, it's just nonsensical to push ahead," he said.

Rural health was also a topic, giving Sen. Amy Klobuchar of Minnesota the opportunity to tout her leadership on bipartisan legislation that would help rural hospitals as well as an immigration bill that would encourage foreign-born doctors trained in the United States to practice in rural areas.

And though the candidates were not asked about abortion rights, the subject came up, briefly and jarringly. Describing how she lost her job as a young teacher when she became pregnant and had no union or legal support to fight back, Sen. Elizabeth Warren of Massachusetts abruptly turned to the allegations of sexual harassment against Bloomberg.

"At least I didn't have a boss who said to me, 'Kill it,' the way that Mayor Bloomberg is alleged to have said to one of his pregnant employees," Warren said, eliciting gasps.

"I never said that," Bloomberg said.

Let's look at what else the candidates claimed.

'The incredible shrinking price tag'

Pete Buttigieg, the former mayor of South Bend, Indiana, took issue with Sanders' changing cost estimates for his "Medicare for All" plan.

"Sen. Sanders at one point said it was going to be $40 trillion, then 30, then 17. It's an incredible shrinking price tag," Buttigieg said. "At some point he said it is unknowable to see what the price tag will be."

Sanders has indeed cited differing estimates of what Medicare for All would cost.

The $30 trillion to $40 trillion figure alludes to work done by the Urban Institute, a Washington think tank. It is the only analysis to factor in the price of long-term care — one of the most expensive components of Medicare for All — and finds the program would cost $34 trillion in new federal spending over 10 years. (In terms of national health spending — both public and private dollars, that is — it would result in an increase of just $7 trillion over a decade.) The research makes assumptions that Sanders' bill leaves open-ended, for instance, estimating what Medicare for All would ultimately pay hospitals and health professionals. Experts note that this is a major hole in Sanders' plan.

The $17 trillion comes from a paper released this month in the medical journal, The Lancet. The researchers say Medicare for All would save $450 billion annually. That would drop the cost significantly, to just about $17 trillion over 10 years.

This figure is what Sanders relies on in calculating his own plan to finance the single-payer plan. His proposed set of revenues would raise about $17.14 trillion in a decade. (For more information on the Lancet study — whose methodology prompted skepticism from many policy analysts — see our full fact check.)

Sanders has also said in at least one interview that the price of Medicare for All is "impossible to predict." This is perhaps the most correct. As analysts repeatedly have told us, the switch to single-payer would represent a shift of unprecedented magnitude in American history. And before you can predict what it would cost, you need to decide what you would pay hospitals and doctors.

Pandemic specialists: Where are you now?

When the debate turned to the global threat of the new coronavirus, COVID-19, Bloomberg, Klobuchar and former Vice President Joe Biden used similar talking points: that President Donald Trump cut global health experts from his national security team, leaving the U.S. unprepared to face the virus outbreak either globally or domestically.

"The president fired the pandemic specialists in this country two years ago," Bloomberg said.

It's true that, in May 2018, the top White House official who was in charge of the U.S. response to pandemics left the administration. Rear Admiral Timothy Ziemer was the senior director of global health and biodefense on the National Security Council and oversaw global health security issues. That global health team was disbanded after Ziemer's departure and reorganized as part of a streamlining effort headed by then-national security adviser John Bolton.

Ziemer's position on the NSC has not been filled in the past two years. Tom Bossert, a homeland security adviser who recommended strong defenses against disease and biological warfare, also departed in 2018.

Last month, Trump announced that Health and Human Services Secretary Alex Azar would be the chair of the coronavirus task force in charge of the U.S. response to the disease. But many are still urging that this position be filled to coordinate the federal response.

Last week, a group of 27 senators sent a letter to current national security adviser Robert O'Brien to ask him to appoint a new global health security expert to the NSC.

Preparedness Funding For Global Infections

Former Vice President Joe Biden said President Donald Trump "cut the funding for CDC."

Trump has consistently proposed funding cuts to the Centers for Disease Control and Prevention. But Congress has consistently overruled him.

Because the comment came during a discussion of the United States' preparedness for emerging global infections like the coronavirus, we looked at the budgets for emerging and zoonotic infectious diseases at CDC, rather than for the CDC as a whole.

The Trump administration's initial budget proposal has consistently been lower than what was spent the previous year. The administration proposed $61.7 million less in 2018 than 2017; $96.4 million less in 2019 than in 2018; $114.4 million less in 2020 than in 2019; and $85.3 million less in 2021 than 2020.

However, Congress usually treats any president's budget proposal as an opening volley, with lawmakers reshaping the federal budget as they see fit when they craft final spending bills.

Every year since Trump has been president, lawmakers have passed bills — bills that were eventually signed by the president — that not only exceeded what Trump had asked for on emerging infections but also exceeded what had been spent the previous year.

The next debate, the 11th of what the Democratic National Committee has said will be 12 presidential primary debates, is scheduled for Sunday, March 15.

PolitiFact's Louis Jacobson contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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