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The Democratic presidential primary has narrowed to a showdown between Joe Biden and Bernie Sanders. In recent days, taking advantage of the binary contest, Sanders has drawn sharp contrasts between himself and Biden — even challenging Biden to a head-to-head debate on health care: Medicare for All is wildly popular with working class and lower income people who understand that we have a dysfunctional health care system. I would love to debate Joe Biden on this issue, give us an hour on MSNBC . . . You want to defend that system? Let’s do it. Although Democratic National Committee chair Tom Perez has rejected calls for single-issue debates, there’s nothing technically stopping the candidates from holding one. Voters deserve more than a few minutes on these subjects, and health care has been the number-one issue for Democratic primary voters. Biden should agree to face off with Sanders. It’s not hard, though, to see why the former vice president is reluctant to answer Sanders’s call — an hour-long debate would reveal Biden’s severe shortcomings on the issue. Sanders is the most trusted candidate on health care. He doesn’t wonkify the subject. He is honest and straightforward, trusting voters to make the kitchen-table calculation that paying a bit more in taxes to eliminate co-pays, premiums, and deductibles is a fantastic deal for the vast majority of people. Despite an onslaught of negative advertising, Medicare for All continues to receive majority support. Biden is dead set against single-payer — but he’s not exactly the polished spokesperson the health insurance industry needs to make its case against Medicare for All. His health plan is bad, and he’s bad at explaining it. And then there’s Biden’s health-care record. Medicare? Biden tried to cut it; Sanders protected it. The Hyde Amendment? Medicare for All repeals it; Biden supported it until last year. Union members? The country’s largest nurses’ union is going door to door for Sanders. Coronavirus? Biden voted against regulating the price of drugs developed with public funding; Sanders introduced that very amendment. No wonder Biden is hiding from Bernie.

Medicare for All Beats Bidencare Sanders’s Medicare for All plan replaces private insurance with a single, publicly run health insurance plan, guaranteeing comprehensive universal health care, free at the point of use. Biden, on the other hand, is running on a patchwork of incremental reforms. His main proposal is to expand Barack Obama’s signature health-care legislation, the Affordable Care Act (ACA). Biden’s plan boils down to throwing more subsidies at the ACA in order to make it profitable for insurance companies to provide affordable coverage. His proposal to cap premiums sounds nice, but it means little when insurers can simply increase deductibles or co-payments. Biden calls for creating a public-option plan to compete alongside private plans. This public option would have no co-payments for primary care, but Biden’s plan is conspicuously silent on other out-of-pocket expenses. And any public option will inevitably be burdened with the sickest and costliest patients. Only a single-payer system can contain costs by controlling drug prices and reining in administrative overhead. Biden promises to tackle the scourge of surprise billing. In 2018, 27 percent of hospital visits resulted in unexpected fees, with charges averaging $3,500. The “free market” clearly fails when consumers are, in fact, patients seeking emergency care. Despite promises to do so, Biden’s plan offers no way to attack this widespread problem. The best solution is to get rid of networks altogether — as Medicare for All would do. In total, Biden’s health-care plan is estimated to cost $750 billion over the next decade, without even achieving universal coverage. In contrast, multiple studies demonstrate that Sanders’s bill would save money. The logic of austerity (“We can’t afford it!”) simply does not hold up for Biden.