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Four health care questions for a better Democratic debate

Bernie Sanders, Joe Biden and Elizabeth Warren, at the last Democratic presidential debate
Photo: Win McNamee/Getty Images

If tonight’s Democratic debate is anything like the earlier ones, it will feature an extended back-and-forth about whether to eliminate private health insurance, and then move on from health care. But there’s a whole lot more that’s also worth asking about.

The big picture: We basically know what the candidates will say about the question of private insurance, because they’ve said it all before. So here are four other questions that might also help illuminate the choice voters face on such a deeply personal, wildly complex topic.

Between the lines: Health insurance — whether it’s a single-payer program or a private plan — pays health care bills. And one distinct feature of the U.S. health care system is that those bills are very high.

The big questions:

  1. We’ve heard a lot of criticism of drug companies and insurance companies, but the single biggest chunk of U.S. health care spending goes to hospitals — about $1 trillion a year. Is that too much? How will you cut it?
  2. If Medicare gains more power to set drug prices, as you’ve proposed, how should it decide what a new drug is worth? What would that decision-making process look like?
  3. Hospitals are closing across rural America. They’re expensive to run, they don’t bring in much money, and doctors are hard to recruit. None of that seems likely to change, so how are rural Americans ever going to get sustainable, affordable in-person care?
  4. Many of the things that make people sick are not the fault of bad health care — they're social factors like poverty, low-quality housing, etc. Should it be part of the health care system's job to address them?