Melania arrived in a pinstripe suit wearing a big white surgical mask. Attendees sat six feet apart. On Tuesday night, President Donald Trump and former Vice President Joe Biden met to debate at the health education campus of Case Western and Cleveland Clinic, one of the foremost medical institutions in country. But over the course of an hour and a half, both failed to tell the American people how we will come out of this pandemic.
The night was dominated in large part by Donald Trump’s interruptions and accusations, which prevented both candidates from addressing any issues in depth. Minutes in, the debate devolved into an accusatory battle over healthcare policy that was virtually unintelligible. Here’s what you need to know about what we learned—and didn’t learn—about the candidates’ stances on health policy.
The Supreme Court’s impact on healthcare
The first question of the debate focused on what to do with the vacancy on the Supreme Court left by Ruth Bader Ginsberg’s passing, but it quickly became about healthcare policy. Former Vice President Biden said he wasn’t opposed to Amy Coney Barrett, Trump’s proposed candidate for the nation’s highest court, but didn’t think the seat should be filled before the election. Then he started trying to untangle what adding Barrett to the court might mean for upcoming court rulings.
At one particularly ridiculous point, Biden and Trump squabbled over whether or not it was likely the Supreme Court might hear a case that would overturn the 1973 decision in Roe v. Wade that allows women the right to access abortion. Trump stonewalled Biden from bringing up the subject of Roe by suggesting it wasn’t under threat of being relitigated.
“You don’t know what’s on the ballot, why is it on the ballot? It’s not on the ballot,” Trump said. “There’s nothing happening there.”
In a recent interview, Planned Parenthood President Alexis McGill told the AP that there are as many as 17 cases challenging state-level abortion bans that could ultimately make their way to the Supreme Court and change the freedoms won under Roe. Trump has repeatedly promised to overturn Roe v. Wade and in particular that he would nominate a judge to serve on the Supreme Court who would support such a decision. His current nominee, Barrett, is a protege of former conservative Justice Antonin Scalia and seems to fit the bill of someone who might find the original Roe v. Wade ruling unconstitutional. Furthermore, there are other similar decisions concerning women’s health that the Supreme Court is likely to weigh in on, like whether medication abortion can continue to be obtained through telehealth versus in-person visits.
The Affordable Care Act
Much of the argument over the Supreme Court’s latest judicial nominee focused on the Affordable Care Act, which also serves as the basis for Biden’s proposed health plan. In particular, Biden raised concerns that Barrett would support a Supreme Court ruling that would deem the ACA unconstitutional, based on writings she’s published in the past.
The Affordable Care Act, also known as Obamacare, provides subsidies to help Americans purchase insurance, has expanded Medicaid coverage in states that allow for expansion, and ensures those with preexisting medical conditions can have medical insurance. The Supreme Court is expected to rule for a third time on the constitutionality of the law in November after the election. Biden argues that if the law goes away, 20 million people could lose their health insurance. He then used this opportunity to remind women in particular why they should care about the ACA.
“If it’s struck down—what happens? A women’s rights are fundamentally changed,” he said. “Once again, a woman can pay more money because she has a pre-existing condition of pregnancy. We’re able to charge a woman more for the same exact procedure a man gets. That ended when we passed the Affordable Care Act. There’s 100 million people with preexisting conditions.”
Biden was referencing the fact that before the ACA, pregnant women who were not insured at the time of conception could be refused insurance. At that time, insurers also sometimes charged women more than men for insurance. The ACA put an end to the practice of using preexisting medical conditions to disqualify insurance applicants and prevented insurers from charging different prices based on gender. It also required insurers to cover maternity services.
In response, Trump attempted to align Biden with Medicare for All, a policy that has been interpreted several different ways by several different politicians. The core idea is that the government could expand publicly funded health insurance options—Medicare and Medicaid—to everyone. Some forms of the policy suggest getting rid of private insurance.
“You’re going to extinguish 180 million people with their private healthcare—well you said you’re going to socialism!” Trump claimed. While other Democratic candidates have embraced the idea of killing off private insurance in favor of a single payer like Medicare, Biden has firmly and repeatedly said he doesn’t want to get rid of employer-sponsored insurance. But he garbled his rebuttal.
“I propose that we expand Obamacare and we increase it,” Biden responded. “We do not wipe any—one of the debates we had with 23 of my colleagues trying to win the nomination and I won—was saying Biden wanted to allow people to have private insurance. They can and they will under my proposal. It’s going to wipe out preexisting conditions and by the way the 200,000 that have died on his watch. How many people will survive? Seven million people have contracted COVID, what does it mean for them going forward if you strike down the Affordable Care Act?”
Biden promised to expand the ACA so that only the poorest Americans, who qualify for Medicaid, will be automatically enrolled in free government-sponsored health insurance. He also said anyone who wants to can keep their employer-sponsored insurance. Considering the large number of unemployed Americans, even just expanding Medicaid to cover more people might provide relief under the pandemic. But Biden didn’t get a chance to elaborate on his policy.
Trump saw to it that Biden could barely discuss any elements of health policy that could change under the next administration—and how it will affect a nation in the grip of a pandemic. Instead, he claimed he will replace the Affordable Care Act with a better version that has cheaper drugs—something he has long promised and failed to deliver on. This month, he signed an executive order that asks Medicare to set up pilot projects wherein it would pay the same low prices for drugs offered in international markets. But critics say the order will be incredibly difficult to pull off. That did not stop Trump from making incredible boasts.
“I’m getting insulin so cheap it’s like water,” he said. But that good cheap insulin doesn’t seem to be reaching Americans. As Stat News reports, most of them are still paying roughly $300 a vial. This is the problem with much of Trump’s purported health policy: it never seems to materialize.
Much of the debate went similarly, with any kind of policy discussion sidelined by interruptions, misleading statements, and crosstalk. Answers about the pandemic and reopening the economy were so light they should be considered malpractice. Rather than discussing what they will do, Biden and Trump spent much of their time bickering over what should have been done.
Trump says he wants to reopen the country and would have a vaccine ready soon. Biden argued that serious drug manufacturers have only said they might have a vaccine by the end of the year but won’t be able to distribute it until the following summer—an idea that the Centers for Disease Control and Prevention officials have agreed with. On the subject of reopening, Biden said if he were elected he would provide businesses with personal protective gear, sanitation resources, and funding to weather any health restrictions that might hurt their business. More than anything, Biden tried to get across that Trump has already failed to protect the American people. “He doesn’t have a plan,” he said. “If I were running it, I’d know what the plan is.”
But what exactly is that plan? Voters watch the debates so they don’t have to read long policy diatribes where they’ll also be battered for campaign contributions. Millions of Americans have lost their jobs and with that their health insurance. Hundreds of thousands have died and some portion of the seven million people who have contracted COVID-19 are likely to suffer long-term health affects. Trump’s program to pay for COVID-19 treatment has confused hospital administrators so much that they are sending astronomical bills to patients, creating further financial hardship for those who lost their jobs. Meanwhile, we are all still living in pandemic, unsure of whether to send our children to school or what to do when winter comes. Neither candidate provided clarity or offered much hope.
“The American people lost tonight,” said CNN anchor Jake Tapper following the discussion. I would submit the American people lost long before the debate began.