The healthcare Clinton and Sanders did—and didn’t—talk about at last night’s debate

By Katie McDonough | January 18, 2016 | 12:00pm

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Sunday night was the fourth Democratic debate, but it was also the NFL playoffs, a fresh episode of Downton Abbey, and the middle of a three-day weekend. If you didn’t watch, which is what the Democratic National Committee seems to want from you, then you missed a few things.

A lot of the debate covered what, at this point in the primary, is familiar territory. Hillary Clinton hit Bernie Sanders on guns, and Sanders hit Clinton on Wall Street.

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Martin O’Malley, who struggled to get his voice in during Sanders’ and Clinton’s many faceoffs, managed to distinguish himself, once again, on immigration. This time around, he was the only candidate to talk about it. (During a segment on privacy and data encryption, O’Malley was also, thankfully, the only candidate to talk quite so much about the federal government trying to get into your front door and back door.)

But the major thing you missed on Sunday night if you were, very reasonably, doing other things was a heated exchange between Clinton and Sanders about healthcare. Who has it, who doesn’t, and why, despite major gains under the Affordable Care Act, it’s still prohibitively expensive or otherwise out of reach for millions of Americans.

It was a debate that deserved to be heard by more people than it probably reached.

Sanders is campaigning on what he’s calling “Medicare for all,” a federally administered, single-payer healthcare system.

His plan, released just before the debate, is still pretty light on actual details about the federally administered part, though he did try to account for how he would pay for it—by taxing the millionaihs and billionaihs, natch, but also through a 6.2% employer premium and a 2.2% tax for most households.

When it comes to selling it to the public, Sanders’ pitch is pretty straightforward: The best way to achieve universal healthcare is by giving everyone healthcare.

“Right now what we have to deal with is the fact that 29 million people still have no health insurance,” Sanders said. On top of the gaps in coverage, Sanders added that the United States is “spending far more per person on healthcare than any other country.”

Clinton, for her part, said she wants to build on the successes of the Affordable Care Act—18 million newly insured, the end of gender rating and discrimination based on pre-existing conditions—as “a path to universal healthcare.”

At this point in the debate, Clinton kind of made it seem like Sanders, by advocating for single-payer, was being rude about President Obama’s signature piece of legislation.

But she also framed her opposition to Sanders’ plan in terms of pure pragmatism. The Republican party has been consistently losing its shit about the healthcare law since it passed in 2010.

So Clinton’s argument basically goes: The fight over a single-payer system would make the theatrics over death squads (and, you know, things like Ben Carson’s suggestion that expanding healthcare to millions of people is the worst thing to happen in the country since slavery) look like a Taylor Swift concert.

“We’ve accomplished so much already, I do not want to see the Republicans repeal it, and I don’t want to see us start over again with a contentious debate,” Clinton said of the healthcare law. “I want us to defend and build on the Affordable Care Act and improve it.”

The entire exchange only lasted about eight minutes, but it opened what is likely to become a much more central debate within the Democratic field: Obamacare has done a lot, but millions of people are still being left behind, and states like, say, Kentucky are dismantling successful exchanges, throwing what was once established coverage into total uncertainty.

So what now?

That was the healthcare the candidates talked about. Then there was the healthcare they didn’t talk about—and haven’t talked about, with rare exceptions.

In all the debate about access to care, not a word was said, once again, about reproductive health, and the ongoing push, in the states and in Congress, to roll back abortion rights.

It seems that, if you want to hear the words “abortion” or “contraception” uttered during a presidential debate, they’re going to come from the mouth of a Republican candidate talking about defunding Planned Parenthood or empowering employers to decide what kinds of services your health insurance will cover.

And, really, there is no better time to talk about the rollback of reproductive rights in this country than while the two leading Democrats debate what they mean when they say “universal healthcare.”