Health care came up right away in Thursday night’s Democratic debate, producing an exchange that revealed how much former secretary of state Hillary Clinton and Sen. Bernie Sanders (I-Vt.) agree on goals -- and how differently they imagine achieving them.
Both Clinton and Sanders support universal health care. That is, both Clinton and Sanders think everybody should be able to pay their medical bills and that only the government can see to that. Both Clinton and Sanders agree that achieving this goal requires action -- even now, with the Affordable Care Act in place -- because millions remain uninsured and millions more with coverage still struggle with their medical bills.
But that’s where the agreement breaks down.
Clinton wants to build on the existing system -- to use the infrastructure that Obamacare has created and improve it incrementally, adding new protections against out-of-pocket costs and getting moderately tougher with the prescription drugs.
Sanders, by contrast, wants to replace existing insurance arrangements with a single, government-run program that would insure everybody and provide far more generous coverage than exists today.
In an early debate exchange, Clinton explained why she favors this step-by-step approach. She thinks the Affordable Care Act achieved a great deal and, more important, she doesn’t want to start a whole new reform effort.
“I don't want us to start over again,” Clinton said. “I think that would be a great mistake, to once again plunge our country into a contentious debate about whether we should have and what kind of system we should have for health care.”
Sanders responded that it was unconscionable to leave people uninsured -- and that he thought the only path forward was to blow up the status quo and build something new, even if it takes a political revolution to do it.
“Every major country on earth, whether it's the U.K., whether it's France, whether it's Canada, has managed to provide health care to all people as a right, and they are spending significantly less per capita on health care than we are,” Sanders said. “So I do not accept the belief that the United States of America can't do that.”
Is Clinton too complacent about the way things are -- or too timid about seeking change? Could Sanders actually overcome the political resistance -- not just from special interests, but also from wary voters -- that his plan would provoke?
How you answer that probably says a lot about which candidate you support.
Read the latest updates on the Democratic debate below: