Hillary Clinton and Sen. Bernie Sanders participate in a Democratic primary debate in Charleston, South Carolina, on Jan. 17, 2016. In their final debate before they face Democratic primary voters, Hillary Clinton and Bernie Sanders traded sharp jabs on health care. Pundits focused on how the barbs would affect the horse race, whether Democrats should be bold and idealistic (Sanders) or shrewd and practical (Clinton), and how Sanders’ "Medicare for All" scheme would raise taxes by a cool $1.4 trillion. (Per. Year. ) Almost no one noticed the obvious: the Clinton-Sanders spat shows that not even Democrats like the Affordable Care Act, and that the law remains very much in danger of repeal. Hours before the debate, Sanders unveiled an ambitious plan to put all Americans in Medicare. According to his web site, “Creating a single, public insurance system will go a long way towards getting health care spending under control.” Funny, Medicare has had the exact opposite effect on health spending for seniors. But no matter. Sanders assures us, “The typical middle class family would save over $5,000 under this plan.” Remember how President Obama promised ObamaCare would reduce family premiums by $2,500? It's like that, only twice as ridiculous. Clinton portrayed herself as the protector of ObamaCare. She warned that Sanders would “tear [ObamaCare] up…pushing our country back into that kind of a contentious debate.” She proposed instead to “build on” the law by imposing limits on ObamaCare’s rising copayments, and by imposing price controls on prescription drugs. Sanders countered, “No one is tearing this up, we’re going to go forward,” and so on. Such rhetoric obscured the fact that the candidates’ differences are purely tactical. Clinton doesn’t oppose Medicare for All. Indeed, her approach would probably reach that goal much sooner. Since ObamaCare literally punishes whatever insurers provide the highest-quality coverage, it therefore forces health insurers into a race to the bottom, where they compete not to provide quality coverage to the sick. That’s terrible if you or a family member have a high-cost, chronic health condition—or even just an ounce of humanity. But if you want to discredit “private” health insurance in the service of Medicare for All, it’s an absolute boon. After a decade of such misery, voters will beg President (Chelsea) Clinton for a federal takeover. But if President Sanders demands a $1.4 trillion tax hike without first making voters suffer under ObamaCare, he will over-play his hand and set back his cause. The rhetoric obscured something much larger, too. Clinton and Sanders inadvertently revealed that not even Democrats like ObamaCare all that much, and Democrats know there’s a real chance the law may not be around in four years. During the debate, Sanders repeatedly noted ObamaCare’s failings : “29 million people still have no health insurance. We are paying the highest prices in the world for prescription drugs, getting ripped off…even more are underinsured with huge copayments and deductibles…we are spending almost three times more than the British, who guarantee health care to all of their people…Fifty percent more than the French, more than the Canadians.” Sure, he also boasted, repeatedly, that he helped write and voted for the ACA. Nonetheless, Sanders was indicting ObamaCare for failing to achieve universal coverage, contain prices, reduce barriers to care, or eliminate wasteful spending. At least one of the problems he lamented—“even more [people] are underinsured with huge copayments and deductibles”—ObamaCare has made worse . (See “race to the bottom” above, and here.) When Sanders criticized the U.S. health care system, he was criticizing ObamaCare. His call for immediate adoption of Medicare for All shows that the Democratic party’s left wing is simply not that impressed with ObamaCare, which they have always (correctly) viewed as a giveaway to private insurers and drug companies. Clinton’s proposals to outlaw some copayments and impose price controls on prescription drugs are likewise an implicit acknowledgement that ObamaCare has not made health care affordable. In addition, her attacks on Sanders reveal that she and many other Democrats know ObamaCare’s future remains in jeopardy. Seriously, does anyone really think Clinton is worried that something might “push[] our country back into that kind of a contentious debate” over health care? America has been stuck in a nasty, tribal health care debate every day of the six years since Democrats passed ObamaCare despite public disapproval. Or that Republicans would be able to repeal ObamaCare over President Sanders’ veto? Clinton knows that if the next president is a Republican, all the wonderful, magical powers that ObamaCare bestows upon the elites in Washington, D.C., might disappear. And she wants Democratic primary voters to believe she is the only Democrat who can win the White House. “The Republicans just voted last week to repeal the Affordable Care Act,” she warned, “and thank goodness, President Obama vetoed it.” Clinton's attacks on Sanders’ health care plan—her warning about “pushing our country back into that kind of a contentious debate” are just a sly way of warning Democratic voters: Bernie can’t win. Nominate me and I will protect ObamaCare. Nominate him, and ObamaCare dies. Perhaps that prediction is correct. Perhaps it isn’t. But it’s plausible. Either way, ObamaCare was the biggest loser in this Democratic presidential debate.
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