Bernie and Ted vs. Obamacare

CNN touted its town hall debate between Sens. Ted Cruz (R-Texas) and Bernie Sanders (I-Vt.) as a battle over the future of Obamacare, but in a sign of how unpopular the health law is, neither man appeared interested in defending the status quo.

Cruz and the self-identified democratic socialist from Vermont offered viewers a taste of what last year’s presidential campaign might have looked like if the primaries had gone a bit differently. They were runners-up to the eventual major-party nominees.

“If you look at these hands across the room, this why people are so unhappy with Obamacare. ‘Cause it isn’t working. Because it was built on an edifice of lies.”

Their showdown at George Washington University offered a sober, substantive alternative to the highly personal and contentious debates between President Donald Trump and Democratic nominee Hillary Clinton in the fall.

Cruz at one point asked audience members to raise their hands if their premiums or deductibles had gone up in the past six years. He asked how many had their insurance plans canceled as a result of new requirements imposed by the Affordable Care Act.

“If you look at these hands across the room, this why people are so unhappy with Obamacare,” he said. “‘Cause it isn’t working. Because it was built on an edifice of lies.”

Sanders argued that the status quo is superior to the health system that America had before the law took effect. He pointed to an increase in the rate of people with insurance, new rules protecting people with preexisting health conditions, and other features of Obamacare. But he expressed little interest in keeping the Affordable Care Act in its current form.

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“Is the ACA perfect? Nobody believes that it is, and nobody believes that we do not need to improve it,” he said. “The ACA has been a step forward. We have got to go further.”

Cruz and Sanders could hardly have presented a sharper contrast in the current debate over health care. It should not have been a surprise to anyone who followed the presidential campaign — both men stuck to the themes they ran on.

Pointing to the Vermont senator’s characterization of insurance companies as greedy, Cruz noted that insurance profits nearly doubled from 2008 to 2015. Sanders agreed and pitched his own solution — the same one he offered during his bid for the Democratic presidential nomination.

“Ted, let’s work together on a Medicare-for-all health care program,” he said.

Cruz argued for reform that would diminish, not increase, the role of government in health care.

“Bernie and the Democrats want government to control health care,” he said. “I trust you. And I trust your doctors.”

In answering questions from the audience and in their exchanges, the senators did a good job of highlighting the challenges of reforming a system in a way that accommodates different interests that often are contradictory. How do lawmakers reduce costs while expanding coverage and improving health services? Most experts believe trade-offs are necessary.

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Sanders said if Cruz and his fellow Republicans have their way and repeal the law, millions of people will lose insurance they gained through expansion of Medicaid. “God only knows how many of them will die,” he said.

But Cruz countered that Medicaid is a troubled program in which a large share of doctors and dentists refuse to participate because reimbursement rates are so low. He said Medicaid recipients are almost twice as likely to die as those with private insurance. He said 742 people on an Illinois Medicaid waiting list died.

The same goes for people with subsidized insurance purchased on the government’s health care exchange, Cruz said. The insurance is of little use if the person who has it cannot afford to use it, he said. He added that 6.5 million people have paid IRS fines rather than buy insurance because they cannot afford the premiums.

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Young people, particularly, have gotten a raw deal, Cruz said.

“It’s a little bit like giving everyone bus tickets when there’s no buses,” he said.

Sanders agreed that unaffordable deductibles are a major problem. He said high costs do the same thing that government regulators in other countries do when they make coverage decisions.

“Please don’t tell me about rationing,” he said. “This country has more rationing than any other nation on Earth, except that the rationing is done by income.”

Amid the wide gulf between Cruz and Sanders, there were a few signs of common ground. Cruz, for instance, suggested that he might be open to letting Medicare negotiate with drug companies for prices. And he supports a proposal by Sanders to let people purchase drugs from countries were the costs are lower.

“There’s no reason why we should be subsidizing other countries around the world,” he said.

But Cruz said the government bears responsibility, too. He said the Food and Drug Administration takes too long to approve new drugs and dramatically raises the cost on pharmaceutical companies.

He said the FDA has approved only three child cancer drugs in the last 20 years. He called for a law requiring approval in 30 days of any drug approved in another major country.

“We should’t have the government putting barriers to people getting the drugs they need,” he said.

Responded Sanders: “I think, Ted, that’s a fair point.”