WASHINGTON — For the most part, substantive debates on health policy between President Biden and former President Trump were overshadowed by mistakes, errors, and blatant falsehoods in Thursday night’s presidential debate.
Biden had difficulty articulating his accomplishments in office and points of contrast with Trump on health care. Trump misrepresented how federal programs work, inflated policies in his tenure, and simply evaded some questions.
Trump did shed more light on his abortion policy stance, while Biden touted his support for abortion rights and efforts to lower drug prices.
But an exchange on Medicare filled with flubbed lines and falsehoods proved to be more the norm. Instead of having a serious back-and-forth about how to fund the program, a misstatement by Biden opened the door for Trump to counter with a false statement.
Biden mistakenly said at one point that “we finally beat Medicare,” which Trump ran with in his response.
“Well, he’s right. He did beat Medicare,” the former president said. “He beat it to death and is destroying Medicare, because all of these people are coming in, they’re putting them on Medicare.” (Trump did not explain how he would shore up Medicare’s solvency.)
People who immigrate to the United States unlawfully are not eligible for the Medicare program. While Medicare’s hospital fund is projected to be insolvent in 2036, that’s five years later than the previous projection.
Biden also misspoke when talking about his signature drug pricing accomplishments, passed in the Inflation Reduction Act.
He claimed that costs for seniors were limited to $15 per month for insulin instead of the $35 cost-sharing cap in the law, and claimed drug costs were capped at $200 instead of $2,000 per year.
Abortion
Biden stumbled when asked about his stance on abortion policy, failing to take advantage of one of his strongest issues among voters. Sixty percent of Americans believe the June 2022 Dobbs decision that removed Roe’s national protections for abortion was a “bad thing,” according to Gallup polling this month.
Trump misleadingly painted Roe’s overturn in 2022 as a universally popular move, saying that “everybody wanted to get it back to the states…without exception, Democrats, Republicans, liberals, conservatives.”
But Trump also said for the first time that he would not “block” access to the abortion pill mifepristone after the Supreme Court ruled unanimously on June 13 that anti-abortion doctors did not have standing to challenge the Food and Drug Administration’s regulation of the pill.
That statement does not preclude him from introducing new restrictions on the medication. Some conservatives have floated resurrecting the 150-year-old Comstock Act to block mail-order prescriptions of the pill; Justices Samuel Alito and Clarence Thomas asked the Biden administration’s lawyer about the law during April arguments on the case.
Trump’s statement reflects his awareness that most Americans do not want broad abortion bans. He emphasized the importance of abortion-ban exceptions in cases of rape, incest and danger to the life of a pregnant person. The former president has distanced himself from total bans in recent months and said that members of his party “poorly handled” the Roe fallout by not prioritizing exceptions.
Reproductive rights advocates argue that exceptions do not work in practice and needlessly endanger patients’ health, as illustrated by the Idaho abortion ban case that the Supreme Court punted back to a lower court on Thursday morning. Biden administration lawyers told the court that since Idaho implemented the law, hospitals have airlifted at least six pregnant women with serious complications to neighboring states because of concerns about penalties.
Biden, when asked if he would support any restrictions on abortion, such as exceedingly rare third trimester procedures, said he supports the protections laid out in Roe v. Wade but stumbled in explaining them.
“We are not for late-term abortion period — period — under Roe v. Wade,” Biden said, using a phrase that abortion rights advocates and obstetricians have spurred. The phrase “late term abortions” has “no medical significance” and is not used in practice, the American College of Obstetrics and Gynecology has said.
But Biden did push back on Trump’s “ridiculous” claim that overturning Roe is universally popular. “The idea that states are able to do this is a little like saying we’re going to turn civil rights back to the states, but each state have a different role,” he said.
Insulin costs and drug pricing
Later on, both candidates sparred over taking credit for lowering insulin costs.
Trump tried to claim credit for capping costs for seniors, saying, “I’m the one that got the insulin down for the seniors. I took care of the seniors.”
Trump did implement a Medicare pilot project that allowed drugmakers and plans to voluntarily offer at least one insulin at $35 per month. An evaluation of the Trump insulin experiment showed that people who used insulin in plans in the pilot had decreased out-of-pocket costs, and filled one additional 30-day prescription a year.
Biden claimed that only one company participated in the Trump-era pilot, which is not true as all three major insulin manufacturers participated. However, Under the Biden administration, the policy got bigger and more permanent when Democrats in Congress codified a $35 per month insulin copay cap for Medicare patients as part of the Inflation Reduction Act passed in 2022.
Under the new law, offering covered insulins at $35 per month became mandatory, not optional, for more insurance plans. The legislative cap applied to insulin delivered through a pump, too.`
In Biden’s closing statement, he stumbled through an accusation that Trump would repeal Medicare’s new authority to negotiate drug prices.
Covid-19 response
Trump also criticized Biden’s Covid-19 response. While taking credit for the development of coronavirus vaccines and therapeutics, he said Biden-era vaccine requirements were a “disaster for our country” and that more people died from the virus during Biden’s administration.
The pandemic began during the last year of Trump’s presidency. While the Centers for Disease Control and Prevention logged more Covid-19 deaths during Biden’s term, deaths per week peaked during Trump’s presidency.
“Everything was often good, but the thing we never got the credit for, and we should have, is getting us out of that Covid mess,” Trump said.
The addiction and drug overdose crisis
Biden and Trump were both asked how they’d help Americans who are dealing with addiction and struggling to get treatment.
They each offered circuitous answers that nodded at border security. Biden mentioned drug-detecting machines. Trump touted drug sniffing dogs.
But one word was conspicuously absent from their answers: “treatment.”
That’s particularly noteworthy because Biden has pushed a number of substantive policies, such as harm reduction, and expanded access to methadone and buprenorphine. The number of overdose deaths, while still near a record high, declined slightly from 2022 to 2023.
The candidates’ ages
Towards the end of the debate, moderators asked both candidates how they would respond to voters’ concerns about their age and capabilities, a question that has loomed large over both campaigns.
Biden said he was the second-youngest person ever elected to the Senate, but largely avoided discussing his age and mental acuity, pivoting instead to claims about technological investments under his tenure.
That response appeared unlikely to satisfy viewers after more than an hour of missteps and confusion. Biden also had a hoarse voice, which he attributed to a cold.
“This debate [is] making abundantly clear that Biden’s insistence on running for another term — when 66% of voters in our swing state poll believe it’s likely he won’t be able to finish a second term — has gravely jeopardized [Democrats’] prospects to defeat Trump,” Dave Wasserman, an election analyst at Cook Political Report, wrote on X.
Trump said he “aced” two cognitive exams — a claim that has been questioned by the test makers — and recently won two golf club championships. “I’m in very good health,” he said. “I’m in very good shape.”
Lev Facher contributed reporting.