Tues, Feb. 7 Senator Bernie Sanders and Senator Ted Cruz debated the future of the Affordable Care Act (ACA) and the overall trajectory of health care in the United States. Their debate is extremely relevant, as President Donald Trump’s first executive order called for a loose interpretation of the ACA and as Congress has signaled the repeal of the ACA within the year. This has resulted in a lot of uncertainty: especially for the 20 million Americans who have obtained health insurance under the ACA. The two recent presidential candidates diverged on many accounts—such as what it means to have a right to health care, the aftermath of an ACA repeal and who should be held responsible for the current obstacles within the U.S. healthcare system. Both agreed that the drug-approval process in the U.S. should be less cumbersome and lower-cost drugs should be permitted to be imported from overseas.

Sanders argued that access to health care should be guaranteed as a right. He regretted that the U.S. is the only developed country that does not assure near-universal health care coverage. This assertion has been verified by the World Health Organization (WHO).

Cruz argued that an individual’s right to health care should mean the right for the individual to choose the health care to which he or she has access; the ACA diminishes the individual’s freedom to choose. He cited that 6 million Americans had their plans canceled contrary to their wishes and that many lost their ability to see their primary care physicians with the new ACA stipulations, and that the average household insurance premiums rose by around $5,000—a reflection of decreased competition in the health insurance market and the fact that insurance companies raised rates to compensate for more risk in the expanded insurance market. Cruz also cited the long wait times and subsequent tragedies that occur in high-income countries with state-controlled coverage; when government rations health care, hospitals become overburdened and less effective he asserted.

“In America, we do rationing in a different way, Ted,” replied Sanders. He alluded to the tens of thousands of Americans who die because they do not see a doctor when they should, due to a lack of affordable insurance.

While Cruz argued that having access to health care means maintaining the right to choose that health care, Sanders asked, “You want to buy one of Donald Trump’s mansions?” He asserted that per Cruz’s definition, “You have access to do that as well,” said Sanders. “Access doesn’t mean a damn thing”—especially for working class Americans.

As for a U.S. without the ACA, Cruz assured a woman from the audience who was battling breast cancer that her policy would not be canceled because of her preexisting condition. Yet, Cruz did not answer if or how an ACA replacement would mandate that insurance companies ignore preexisting conditions for future policies.

Both Sanders and Cruz mentioned that doctors seem to spend more time filling out forms than they do practicing medicine. Cruz argued this is due to ACA forms; Sanders claimed that this drain on doctors’ time comes from insurance companies, further supporting his end goal of booting insurance companies out of health care and joining the rest of the developed world with a single-payer health care system.

Cruz implored Sanders to join him in a fight to curtail the power of the U.S. pharmaceutical industry and the Federal Drug Administration (FDA).

“Right now, it takes 2 billion dollars to approve a new drug,” Cruz said. “I’ve written legislation to reform the process so we can be curing diseases and curing people.”

Expenses driven by the FDA dissuade drug developers from bringing life-saving drugs to the market and FDA regulations bar international drugs from entering the U.S. market, he asserted. Though disagreeing on the normative power of the FDA, both senators agreed that less-expensive drugs should be imported from abroad.

Cruz did not adequately answer how his alternative to the ACA would expand access to health care for individuals with preexisting conditions while increasing competition and empowering patients; Sanders failed to answer how businesses are expected to shoulder mandated insurance without raising prices or cutting wages. However, this health care conversation is far from over, and these two senators specifically, who are both prospective 2020 presidential candidates, are not through debating.

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