Joe Biden, Bernie Sanders and Elizabeth Warren For all of their interruptions and talking overeach other, candidates offered a few thoughtful answers on keyhealth care issues. (Photo: Bloomberg)

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

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With Democrats in 15 states and American Samoa set to cast theirprimary votes in the next week, the candidates eagerly seized theirchances on the debate stage in Charleston, South Carolina, to jab Sen. BernieSanders of Vermont, the current front-runner, during the party's10th debate.

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Related: Democrats debate whether 'Medicare for All' isrealistic

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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 leastdecriminalizing marijuana and expunging past, small-scale marijuanapossession charges from Americans' criminal records.

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Sanders said he would remove marijuana from the list ofcontrolled substances on the first day of his presidency and addedthat he would empower black, Latino and Native American communitiesto start businesses selling the drug legally, rather than leavecorporations to fill what is already a lucrative market.

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

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Rural health was also a topic, giving Sen. AmyKlobuchar of Minnesota the opportunity to tout her leadership onbipartisan legislation that would help rural hospitals as wellas an immigration bill that would encourage foreign-born doctorstrained in the United States to practice in rural areas.

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And though the candidates were not asked about abortion rights,the subject came up, briefly and jarringly. Describing how she losther job as a young teacher when she became pregnant and had nounion or legal support to fight back, Sen. Elizabeth Warren ofMassachusetts abruptly turned to the allegations of sexualharassment against Bloomberg.

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

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"I never said that," Bloomberg said.

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Let's look at what else the candidates claimed.

'The incredible shrinking price tag'

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

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"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 whatthe price tag will be."

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

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The $30 trillion to $40 trillion figure alludes to work done bythe Urban Institute, a Washington think tank. It is the onlyanalysis to factor in the price of long-term care — one of the mostexpensive components of Medicare for All — and finds the programwould cost $34 trillion in new federal spending over 10 years. (Interms of national health spending — both public and privatedollars, that is — it would result in an increase of just $7trillion over a decade.) The research makes assumptions thatSanders' bill leaves open-ended, for instance, estimating whatMedicare for All would ultimately pay hospitals and healthprofessionals. Experts note that this is a major hole in Sanders'plan.

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

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

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Sanders has also said in at least one interview that the priceof Medicare for All is "impossible to predict." This is perhaps themost correct. As analysts repeatedly have told us, the switch tosingle-payer would represent a shift of unprecedented magnitude inAmerican 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 globalthreat of the new coronavirus, COVID-19, Bloomberg, Klobuchar andformer Vice President Joe Biden used similar talking points: thatPresident Donald Trump cut global health experts from his nationalsecurity team, leaving the U.S. unprepared to face the virusoutbreak either globally or domestically.

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

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It's true that, in May 2018, the top White House official whowas in charge of the U.S. response to pandemics left the administration. Rear Admiral Timothy Ziemer was thesenior director of global health and biodefense on the NationalSecurity Council and oversaw global health security issues. Thatglobal health team was disbanded after Ziemer's departure andreorganized as part of a streamlining effort headed bythen-national security adviser John Bolton.

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Ziemer's position on the NSC has not been filled in the past twoyears. Tom Bossert, a homeland security adviser who recommendedstrong defenses against disease and biological warfare, alsodeparted in 2018.

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

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

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Preparedness Funding For Global Infections

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

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Trump has consistently proposed funding cuts to the Centers forDisease Control and Prevention. But Congress has consistentlyoverruled him.

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

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

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

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Every year since Trump has been president, lawmakers have passedbills — bills that were eventually signed by the president — thatnot only exceeded what Trump had asked for on emerging infectionsbut also exceeded what had been spent the previous year.

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The next debate, the 11th of what the Democratic NationalCommittee has said will be 12 presidential primary debates, isscheduled for Sunday, March 15.

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PolitiFact's Louis Jacobson contributed to thisstory.

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Kaiser HealthNews (KHN) is a national health policy news service. It is aneditorially independent program of the Henry J. Kaiser Family Foundation whichis not affiliated with Kaiser Permanente.

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