Despite 12 candidates shoe-horned on the stage, last night’s debate was important. Health care was a key issue in the 2018 mid-terms, a winning issue for the Democrats. Nothing has changed since then. But drilling down into the details is crucial if the vision of health care for all is to become reality. The debate helped to clarify the differences between the Medicare-for-All candidates, Elizabeth Warren and Bernie Sanders, and the Medicare-for-All-If-You-Want-It candidates,  like Joe Biden, Amy Klobuchar and Pete Buttigieg. They’d offer a public option but wouldn’t deprive tens of millions of Americans of their private coverage if that’s what they choose– as as with workers who won that option in hard fought union negotiations.

If you liked Elizabeth Warren going in, you were pleased with her staying on message and not wilting under increasing attacks by more center-left (read, incremental change) candidates.  If you thought her approach to Medicare for All is a costly “pipe dream,” damaged by eliminating patients’ ability to choose private insurers, then you were exasperated that you never got answers on how much her vision will likely cost and who is really going to pay more while losing choice. At least Bernie Sanders will answer the question, saying, yes, taxes will go up but premiums and co-pays will go away so net costs to the middle class will go down. Still,  details on his bill’s total costs, which Warren supports, and estimated by  Biden at more than $30 trillion over a decade, are still fuzzy.

Perhaps Warren fears Trump will lift her candid response out of context into a TV ad and “Harry-and-Louise” her on the issue.  He surely would. But now she risks sounding like another George Bush “read my  lips, no new taxes” politician and undermining her reputation for rigorous intellectual honesty and refreshing candor. Warren  has plans for some of the most pressing public policy challenges and proposes sources to pay for them. But, on this issue of transcendent importance, she’s disappointingly opaque. Opining that there are many revenue streams that can be used doesn’t cut it. She insists she won’t raise costs for “the middle class,” but will the revenue stream from taxing billionaires and corporations be enough to cover health care plus all her other social programs? Those who’ve worked with Warren say, notwithstanding her  rhetoric, she can be pragmatic. It’s time for her to pivot.

Amy Klobuchar had her best night by far, was eloquent in her closing remarks and was the only candidate to address other looming health care costs such as the financial burden of long-term care for an aging population. Both she and Pete Buttigieg were composed but assertive, articulate and strong, leaving doubt only as to whether they can actually translate the performance into  poll standing. Buttigieg has done well with fundraising, but Klobuchar risks missing out in in the next debate. It would be unfortunate if her performance last night were the high point of  her campaign. If  either of the two were to get  more traction, will their new supporters come from Warren’s college educated donors  or from Joe Biden’s working class heartland, with whom they are more philosophically aligned?

If you went in really liking the best of Joe Biden, thinking he’d do fine if elected President but fearing he’s not up to the challenge of sustaining a top-notch campaign, your doubts probably remain.  His moments of righteous anger against Donald Trump are outweighed by his garbled responses and tortured syntax, what one TV commentator calls “word salad.”  You hold your breath rooting for him to be more cogent but rarely getting there.  You want to protect him from the exposure but scream at him for not being better prepared to answer questions about his son’s capitalizing professionally on his father’s position. One looks for a shining break-through moment in each debate, but it never comes.  So the putative leader has gone from solid first place to a more tenuous grip shared with or just behind Elizabeth Warren.

Bernie Sanders was back full steam after his heart attack, though one wonders if his slightly less angry persona was to compensate for having come on too strong in the last debate or if he was tiring as the grueling three-hour debate ground on.  Give him credit: he is a fighter and true to himself.  His calls for a political revolution are authentic, and that’s what makes him scary for older generations and exciting for younger ones. (Remember: if you aren’t a revolutionary by age 30, you have no heart. If you’re still a revolutionary after 30, you have no head!)

Cory Booker wants to slide by on charm and kumbaya values but sounds more and more like a calendar whose monthly pages are dotted with Zen aphorisms. Still, his final comments calling for a return to civic grace are a welcome addition to public discourse. Beto O’Rourke has become a one-issue candidate (guns an important issue, to be sure) and sounded surprisingly flat.  Kamala Harris has never mastered the ability to combine her prosecutorial background with her whiny every-person anecdotes, often about her mother. She was, however, quite stirring on reproductive rights. Andrew Yang has become increasingly sure of himself,  has struck a chord with millenials concerned about the future, and rightfully  called out Warren for diminishing the importance of automation on tomorrow’s workforce. It’s still hard to see him bursting out of the second or third tier.

Among the fading were Tom Steyer (whose campaign and Christmas tie are a tributes to what money can buy), Tulsi Gabbard (whose outrage at conspiratorial attacks on her is at odds with her overwhelming support in the post-debate Drudge poll), and Julian Castro (who remains a good candidate to lead an agency – been there, done that, could do so again).

The greatest unasked question from last night is one  of paramount concern: what would each specifically do as president to combat the existential threat of climate change, what lifestyle changes will be required and what will short and long-term solutions cost. That no one even asked the question was appalling.

The Iowa caucuses are a little more than 100 days off. All the candidates would be better than Trump, many exceptionally better.  We need to keep reassuring ourselves that the grueling pre-primary process will clarify a few behind whom the country can rally in order to preserve our experimental democracy. We need to keep focused, pay attention, support financially to the extent we can and remember how low the incumbent has brought the office of the President of the United States, the Leader of the Free World.  As more than one candidate observed, this election is about who we are and what this nation shall be.

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