The two — who are among the most ideologically rigid legislators on Capitol Hill — engaged in political sparring in front of a red, white and blue backdrop similar to those used in presidential debates. (Neither Sanders nor Cruz has ruled out a White House run in 2020.)
The debate came as the Republican-controlled Congress grapples over how to replace the Affordable Care Act, known as Obamacare. Republicans have initiated the process to repeal the law, but the party has not unified around a comprehensive replacement plan.
Democrats, who are in the minority in Congress, have mounted a rhetorical war against repealing the law, contending that, while not perfect, it has slowed the rise in health care costs and resulted in 20 million more Americans being insured.
During Tuesday’s debate, Sanders vociferously defended the ACA while arguing that America should adopt a single-payer system. He warned that any Republican plan to reform health care would result in fewer government protections and mandates, and that the 32 states that expanded Medicaid under Obamacare would see a loss of federal support.
“If you are one of 20 million Americans who finally has received health insurance, forget about it — you’re gone,” Sanders said about a potential repeal. “That means when you get sick, you ain’t gonna be able to go to the doctor. And when you end up in the hospital, you’ll be paying those bills for the rest of your life, or maybe you’ll go bankrupt.”
Cruz argued that the election results gave Republicans a mandate to repeal the ACA, which he portrayed as an unwarranted intrusion into the private lives of American citizens. The Texas senator favored scaling back government regulations over health care in favor of a free market approach. The result, according to Cruz, is that care would improve and price would decrease.
“Bernie and the Democrats want government to control health care,” Cruz said. “I trust you. And I trust your doctors. I think health care works better when you’re in charge of your family’s health care decisions, when you can sit down with your doctor and decide the care that’s best for your family without government setting rules, without government rationing, without wait periods.”
Cruz said Sanders’ sunny portrayals of universal health care systems in Europe and Canada were disingenuous and didn’t acknowledge the rationing of care.
“You know, the governor of one of the Canadian provinces came to America to get heart surgery, and he was a governor in Canada,” Cruz said. “And, by the way, in your home state of Vermont, your hospitals advertise with Canadian flags, ‘Come to American hospitals, you’ll get better health care.’”
Sanders acknowledged that universal health care systems were not perfect, but he shot back, saying that although wait times for care can be long, single-payer systems do not discriminate economically.
“Please, don’t tell me about rationing,” Sanders said. “This country has more rationing than any other industrialized country on Earth, except the rationing is done by income. And working-class people and poor people today are suffering as a result of that rationing.”
A recent study by the Commonwealth Fund comparing the quality of care in the U.S. and five other developed countries found that — despite spending twice as much per capita — this country ranks last or near last on performance measures of quality, access, efficiency, equity and healthy lives.
While the two legislators disagreed on much, they came together to blast a common enemy: the pharmaceutical industry.
In January, Cruz voted in favor of a Sanders budget amendment to allow for the importation of prescription drugs from Canada in order to lower prices.
Cruz said drug reimportation is “the right thing to do,” adding that he was also focused on reforming the Food and Drug Administration to allow for easier approval of prescription drugs.
“I introduced legislation that said if a drug is approved in another major country, if it’s approved in Europe or Japan or our major respected partners, that the FDA has got 30 days to approve it here,” Cruz said. “We shouldn’t be telling people with life-threatening diseases you can’t do everything you can to save your lives.”
Both Sanders and Cruz also railed against insurance companies.
“In 2008, the 10 largest insurance companies in America made just over $8 billion profit,” Cruz said. “In 2016 — 2015, rather — those same 10 largest companies made $15 billion in profit. Insurance company profits have doubled under Obamacare. That was the result.”
Sanders responded, “I find myself in agreement with Ted.”
“He’s right,” Sanders continued. “The function of insurance companies is not to provide quality health care to all people. It’s to make as much money as they possibly can.”
Sanders then proposed Cruz work with him on a Medicare-for-all system, “so we’re finally going to get insurance companies, private insurance companies, out of our lives.”
After laughs from the audience, Sanders acknowledged the reality.
“You’re not going to support that,” Sanders said. “I know that.”
