Senator Bernie Sanders epitomizes the “Medicare for All” proposal. Vice President Joe Biden is the chief proponent of building on the Affordable Care Act. These are two very different ways to get to universal coverage with very important policy differences that merit serious thought and rational debate.

Senator Kamala Harris has outlined her own health plan for all Americans. Like Senator Bernie Sanders, she covers everyone. Like Senator Sanders she offers comprehensive benefits. Like Senator Sanders, she eliminates copays and deductibles, and premiums. She departs from Senator Sanders on three issues: the role of private insurance, the financing and the length of transition.

The debate between Senator Harris and Vice President Biden on school busing evokes memories from my past.

Here we are celebrating the extraordinary American moon landing achievement of 1969. It was also the time of great advances in civil rights, in health coverage for seniors, the disabled and the poor, and of a nation divided by the Vietnam War and the end of legal segregation – the American version of apartheid.

If it walks like a duck, quacks like a duck and hangs out with other ducks, good chance it’s a duck.

Financing Medicare for All is far better done at the federal than at the state level. Senator Sanders and others seek to do so in both the Senate and the House and it's a key issue in the Presidential campaign.

The Biden plan would offer more affordable coverage to all American citizens and legal residents. It does not help cover the undocumented.

For the next decade, we will be running annual budget deficits equal to about 4.5% of GDP as compared to the last 50 years where it was 2.9% of GDP. The levels of budget deficits will require an increasing share of the federal budget to be spent on interest payments to those who hold Treasury notes and other federal securities. Federal taxes are bringing in revenues of roughly 16% of GDP while federal spending is running at about 20.5% of GDP. The Presidential election in 2020 is crucial to the nation’s financial future.

The Medicare for America Plan, HR 2452 (DeLauro and Schakowsky), gives all Americans a choice of Medicare or private insurance. Individuals can choose public coverage through Medicare or private coverage through their employer or private coverage through a Medicare Advantage plan.

There are four Public Option bills – S 3 (Cardin), S 1261 and HR 2462 (Merkeley and Richmond), S 981 and HR 2000 (Bennett, Kaine and Delgado), and HR 2085 and S 1003 (Schakowsky and Whitehouse) . They give participants in the Exchanges (like Covered California) the option to choose a plan offering Medicare coverage. Some increase premium assistance and cost sharing reductions; others do not. All leave existing coverage through Medicare, Medicaid, CHIP, and employer plans unchanged.

There are two different Medicare for All Plans in Congress: Senator Sanders S 1129 and Representative Jayapal’s HR 1384. They are comparable, but with a few salient differences. Both cover all Americans for a comprehensive set of benefits with no cost sharing or premiums, using a Medicare-like payment program. Both eliminate all employer and individual private insurance and the existing Medicare program and most of the Medicaid program as well (Senator Sanders retains it for institutional long term care – i.e. nursing homes. Neither eliminates the VA programs for veterans or the HIS program for Native Americans.

Covered California released its initial report on premiums, premium assistance and plan participation for the coming year (2020). Premiums are down; plan participation is up; coverage is more affordable, and subscriber participation is expected to increase.

There are lots of conflicting signals.

The United States of America has been a beacon of hope – starting with the Declaration of Independence, the Revolutionary War, the founding of the United States of America and the enduring principles of the United States Constitution. We fought a Civil War to end the unspeakable crime of slavery. We welcomed immigrants fleeing poverty, persecution and violence.

We also have many episodes of our history that we must remember with shame, and we must acknowledge our grievous harm to many innocents.

I have been re-reading the stirring words and the history leading up to our Declaration of Independence and reflecting how our founding fathers were prepared to lay everything on the line – their lives and their fortunes – to bring us the freedoms we enjoy, and may take too much and too comfortably for granted today.

The Democratic debates featured a split between those supporting Universal Health Coverage and those supporting Medicare for All. There is a huge difference that needs to be understood as voters begin to assess these issues being espoused by the candidates. There is a vast amount of misinformation being spread on all sides that really confuses people.

There were 20 well-spoken and thoughtful candidates – any of whom would be a huge step forward from President Trump. The debates were thoughtful, informed and respectful – a far cry from the name-calling and school yard bullying and ridicule that characterized President Trump and his Republican challengers in 2016.

President Trump and his cabinet secretaries and his political appointees take oaths of office to abide by the Constitution and to faithfully execute the laws of the land.

The Governor and State Legislators have agreed to fund new coverage opportunities for the uninsured.