ARI SHAPIRO, HOST:
Last night, the Democratic presidential candidates met for their last debate before the voting begins in Iowa two weeks from today. It was broadcast on NBC, and one big area of disagreement was health care. We're going to break it down.
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WALTER MONDALE: Where's the beef? When I hear your new ideas, I'm reminded of that ad. Where's the beef?
SHAPIRO: NPR's Danielle Kurtzleben and Scott Horsley are back in the studio with us to walk us through some of these health care questions. Welcome back, folks.
SCOTT HORSLEY, BYLINE: Good to be with you.
DANIELLE KURTZLEBEN, BYLINE: Thank you.
SHAPIRO: Just before the debates started, Vermont Senator Bernie Sanders released some details of his single-payer health care plan which he calls Medicare for All. He complains the Affordable Care Act has not done enough to rein in costs. Let's listen.
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BERNIE SANDERS: Tell me why we are spending almost three times more than the British who guarantee health care to all of their people, 50 percent more than the French, more than the Canadians.
SHAPIRO: Scott, are those numbers right? Is the U.S. really paying that much more?
HORSLEY: We are. The U.K. spends a little over $3,000 per person on health care, France and Canada - between four and $5,000 per person and the U.S. - nearly $9,000 per person.
SHAPIRO: Wow.
HORSLEY: At the same time, on a number of indicators, we have worse outcomes, so we're spending more with little or nothing to show for it. Sanders says you could cut costs by switching to a single-payer system like the ones in the U.K. and Canada.
SHAPIRO: And Sanders says he would pay for that system with a variety of taxes. And he was asked if some of those taxes might hit the middle class. Here's what he said.
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SANDERS: We are doing away with private health insurance premiums. So instead of paying $10,000 to Blue Cross or Blue Shield, yes, some middle-class families would be paying slightly more in taxes, but the result would be that that middle-class family would be saving some $5,000 in health care costs.
SHAPIRO: Danielle, is that true that every middle-class family that pays more in taxes will be saving even more in health care costs?
KURTZLEBEN: Every middle-class family - that's probably stretching it a bit. Now, this gets at how he's funding this. He's increasing taxes that will hit the richest Americans the most. He's increasing payroll taxes. And this is what he's talking about here - this 2.2 percent tax that will hit at families earning around $29,000 or higher, and that is what he means when he's talking about the middle class.
They'll end up paying, yes, 2.2 percent more. Now, what Sanders is saying here is that also, yeah, you're paying new taxes, but subtract out what you're paying right now for what health care you're getting, the premiums you're paying. And what you would get under Sanders' plan is a co-pay-free, deductible-free health care plan.
SHAPIRO: Medicare for All, as he puts it, provided by the government.
KURTZLEBEN: Right.
SHAPIRO: Now, Hillary Clinton argued last night that it is impossible to pass a plan like that because even when Democrats controlled the House and Senate at the beginning of President Obama's first term - wasn't doable. Let's listen.
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HILLARY CLINTON: There was an opportunity to vote for what was called the public option. In other words, people could buy into Medicare. And even when the Democrats were in charge of the Congress, we couldn't get the votes for that.
SHAPIRO: Scott, you covered the debate over the Affordable Care Act in 2009, 2010. Is she right?
HORSLEY: She is right. The Obama administration was unable to push through support for government-run insurance as an option, let alone the only option. And, of course, since then, Congress has just moved to the right. This debate, though, over political feasibility really highlights a difference between Clinton, who calls herself a pragmatic progressive focused on what's possible in the current political environment, and Sanders, who says, look; you got to change the political environment so more possibilities open up.
SHAPIRO: Another point of disagreement was that Hillary Clinton accused Bernie Sanders of effectively being disloyal to President Obama seeking a primary opponent to run against him in 2011. Let's listen to Sanders in a radio interview in 2011 on the Thom Hartmann radio show.
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SANDERS: One of the reasons the president has been able to move so far to the right is that there is no primary opposition to him. And I think it would do this country a good deal of service if people started thinking about candidates out there to begin contrasting what is a progressive agenda as opposed to what Obama is doing.
SHAPIRO: And Sanders said last night he worked hard to re-elect President Obama. Danielle, what's going on here?
KURTZLEBEN: Right. So what you had last night was the absolute opposite of what you've been seeing in the GOP debates, where they're trying to distance themselves as far from President Obama as possible. What you saw last night were the candidates trying to cozy themselves up to Obama, who remains very popular among primary voters. So right now, that looks like a great strategy. In a general election, though, it might be different story.
SHAPIRO: NPR's Scott Horsley and NPR's Danielle Kurtzleben, thanks to you both.
HORSLEY: You're welcome.
KURTZLEBEN: Thank you.