As health care shapes up to be a top issue in the 2020 presidential elections, Tuesday’s Democratic debate in Westerville helped to define key differences among challengers to President Donald Trump.



The election might be a year away, but with Ohio’s presidential primary coming March 17, it is not too early for voters to get serious about evaluating where candidates stand on the issues they care about most.



Regarding health care, on the far left flank of Democratic contenders are the "Medicare for All" proposals of Sens. Bernie Sanders and Elizabeth Warren.



Less extreme is the call by South Bend, Indiana, Mayor Pete Buttigieg for "Medicare for All Who Want It," which would offer a public option for those who prefer a government health insurance program before they are eligible for Medicare at age 65.



Sen. Kamala Harris of California used some of her time on the stage at Otterbein University to bring women’s health issues into the conversation as she called out Republican state legislators across the country for increasing restrictions on reproductive rights, and Sen. Cory Booker picked up the baton to say men should also champion women’s health care issues.



More conservative among Democrats are former Vice President Joe Biden and Sen. Amy Klobuchar of Minnesota, who both call for building on Obamacare, the federal health care reform law passed during the administration of President Barack Obama.



As Sanders describes it, his Medicare for All plan sounds more utopian than the actual government health coverage plan for those 65 and older. Sanders advocates universal health care access with no premiums, deductibles or copays. That goes beyond the existing Medicare system in which senior citizens typically pay a monthly premium for hospital and physician coverage and most also buy supplemental insurance to cover what Medicare doesn’t.



While Sanders readily admits his plan would levy taxes to pay for coverage, he contends families would still pay less than what it costs them for private health insurance and that the wealthy and corporations would pay more.



Warren, who rose in polls to become Democrats’ frontrunner this week, supports Medicare for All but lost credibility in Tuesday’s debate by continuing to duck direct questions about how she would pay for it, insisting she would "not sign a bill into law that does not lower costs for middle-class families."



The notion of dismantling the nation’s extensive private insurance market and putting all Americans into a government program is too extreme for most voters to stomach, no matter how it’s funded.



Buttigieg is more mainstream; his proposal would leave existing private insurance in place but add a public option for the uninsured, making it free to low-income families and subsidized for middle-income families. He would cap health insurance premiums at no more than 8.5% of an individual’s income to hold down private insurance costs.



Klobuchar and Biden also would seek to strengthen the existing health care system.



Klobuchar proposes an option to allow the uninsured to buy into Medicare (public health insurance for those 65 and older) or Medicaid (public health coverage for low-income and disabled persons).



Biden calls for a Medicare buy-in option and, like Buttigieg, he would cap the cost of private insurance at 8.5% of a person’s income.



The viability of these seven candidates’ campaigns will rise or fall in coming weeks in large part on their health plans.