Sen. Bernie Sanders' CNN health care debate with Sen. Ted Cruz Tuesday night was a case study of the competing visions of social justice and free market fundamentalism.

The ostensible frame of the debate was on the expected repeal of the Affordable Care Act.

But the presence of Sanders on the stage changed the discourse to a broader contrast of compassion or a ruthless you're on your own society.

What Sanders articulated so well is the vision of humanism and hope that animated his Presidential campaign.

That healthcare must be a fundamental human right. That we are "in this together," and not just in words, or as he said in a South Carolina town hall during his campaign, "that when you hurt, when your children hurt, I hurt."

That we live in a country over stuffed with legislators, the corporate donors who fund them, and the far right policy wonks, who arm them with Ayn Rand-style ideas that elevate privilege and greed to a moral imperative.

Or in health care, a system of money over care, of profiting off human suffering and pain, that is a death sentence for so many.

Speaking on behalf of the repeal and replace crowd, Cruz hammered away at the central Tea Party theme, "freedom" from "government" mandates (unless it is dictating the rules of women's health choices, of course).

Accompanied by the misleading mythology of the market, that with private insurance you have the "freedom" to choose your doctor, to design the health plan you want, and to pay what you want.





Truth at this stage seems to be of marginal value in a country divided in so many ways.

The backdrop is a long campaign, carefully orchestrated by the American Legislative Exchange Council (ALEC) and others to convince working people across the country that government, not Wall Street, not corporations, is to blame for a country that fails them.

Thus the false narrative that government programs, including safety net measures that are essential to maintaining a civil society, and regulations, public protections, such as clean air and water and food safety, are an impediment to jobs and economic security.

It's especially a fraud in health care, which remains in the iron grip of corporations, which accumulate massive profits by denying care or setting prices so high, with virtually no limits on what they can charge, that have created a cruel system based on ability to pay.

Thus, a highlight of the debate, Bernie calling out Cruz on whether health care is a right. Cruz' response, "access to care" is the right. To which Bernie aptly responded, as he had earlier to Rep. Tom Price, the rightwing ideologue tapped as Health and Human Services Secretary: "access" is not care if you can't afford it.

The sad irony of the ACA is that it was a convoluted attempt to straddle both worlds - public mandates, including the expansion of Medicaid, curbs on many insurance abuses, and a number of required benefits for ACA plans, with multiple handouts to entrench and enrich healthcare corporations, from insurers to hospitals to drug companies.

The result - the Republicans are right, the ACA out-of-pocket costs are out of control and the insurance networks are limited. But that's because the ACA was modeled on a Republican-Mitt Romney plan in Massachusetts with mechanisms set in place to protect the healthcare industry.

And, all the replacement schemes envisioned by Cruz and his cohorts would make it even worse. Their rhetoric and crocodile tears over costs under the ACA are a convenient stalking horse for "replacement" plans that would not guarantee lower costs, but even greater license for corporations to charge all that they can get.

They would shut even more people out, letting them die if they cannot afford the inflated costs or trapped in a byzantine scheme of health savings accounts, high risk pools, or bare bones insurance plans, all premised on how much you can pay.

Only one replacement plan would actually fix the real holes in the ACA, and the far greater pre-ACA disaster that saw the U.S. plummet to 37th in world rankings on access, cost, and quality early in this century. That is, of course, as Sanders emphasized in his campaign, and in the debate, an improved Medicare for all.



Here's a table, comparing and contrasting health care before the ACA, with the ACA fixes and limitations, what the Republicans propose today, and what an actual humane system would look like.