Health care and Medicare for All took center stage at the Democratic debate in Las Vegas on Wednesday, and the debate got nasty fast.

“We need to get everybody’s health care plan out here,” said Sen. Elizabeth Warren. “Mayor Buttigieg really has a slogan … that would leave millions of people unable to afford their health care. It’s not a plan. It’s a PowerPoint. And Amy’s (Sen. Amy Klobuchar’s) plan is even less. It’s like a Post-It note.”

“So my plan is a public option, and according to all the studies out there, it would reduce premiums for 12 million people immediately,” Klobuchar fired back. “It would expand coverage for about that same number. It is a significant thing. It is what Barack Obama wanted to do from the very beginning.”

Sen. Bernie Sanders is now the lone proponent of a Medicare for All, single-payer health care plan.

“Somehow or another, Canada can provide universal health care to all their people at half the cost,” Sanders said. “U.K. can do it. France can do it. Germany can do it. All of Europe can do it. Gee-whiz, somehow or another, we are the only major country on Earth that can’t do it. Why is that? And I’ll tell you why. It’s because, last year, the health care industry made $100 billion in profits. Pharmaceutical industry, top six companies, $69 billion in profit. And those CEOs are contributing to Pete’s campaign and other campaigns up here.”

“The function of a rational health care system is not to make the pharmaceutical industry and the drug companies rich,” Sanders said. “It is to provide health care to all people as a human right, not a privilege. No premiums, no copayments, no deductibles.”

Former Vice President Joe Biden noted that with Warren’s shift away from a Medicare for All program to an optional government plan, all the candidates at the debate now support his original plan.

“I notice what everybody’s talking about is the plan that I first introduced,” Biden said. “That is to go and add to Obamacare, provide a public option, a Medicare-like option. … It cost a lot of money. It cost $750 billion over 10 years. But I paid for it by making sure that Mike and other people pay at the same tax rate their secretary pays at.”

“When you ask Bernie how much it costs,” Biden said, “he said, ‘We’ll find out’ … or something to that effect. It cost over $35 trillion bucks. Let’s get real.”

So how realistic is Medicare for All?

Not very, says Bruce Japsen, senior contributor to Forbes.com and WBBM News Radio on health care. He’s also author of the book, “Inside Obamacare.”     

Below, an edited Q&A with Japsen:

How realistic is Medicare for All?

The Medicare for All that Sen. Sanders wants is the single-payer that would put private health insurance companies out of business. Imagine, if you will, Blue Cross Blue Shield of Illinois, they employ hundreds and thousands of people there. Their parent company, Health Care Service Corporation, is based in Chicago. In Sen. Klobuchar’s home state of Minnesota, United Healthcare is there. That’s the nation’s largest health insurance company. We just expanded health care coverage under the Affordable Care Act and we did it through private companies. So, all of these private companies would cease to exist under a single-payer health care plan. Politicians don’t like to get rid of jobs. And this would put private insurance companies out of business.

Sanders said last night that a number of countries have government health insurance. So why can’t this happen in the U.S.?

It’s too entrenched. The private insurance industry, it’s just too entrenched. We’re just too used to it. I mean, I think that they could incrementally do it. And now you have, also, private insurance companies sell Medicare coverage known as Medicare Advantage. Seniors love Medicare Advantage plans. So what are you gonna do? You’re gonna say, um, your Blue Cross Medicare plan, you can’t have that anymore because we’re going to go to Medicare for All? It’s a real potential problem for Sen. Sanders. People don’t like things taken away from them. But in the Medicare for All that Sen. Sanders is proposing, it’s pretty sexy when you say, “Hey, I don’t have to pay a copay anymore. I don’t have to pay a deductible anymore. And that’s the only plan that I’m going to have to deal with.” People would like that. 

But I think where the problem comes in is the throwing out of how much it would cost and how it would be paid for and the fact that a lot of people in the private sector would lose their jobs. And there’s employer plans, too. Employers have plans, unions have plans. Maybe a Medicare for All would be better, but you know how people are and they’re like, don’t take that away from me.

Japsen joins “Chicago Tonight” along with Dr. Claudia Fegan, the National Coordinator of Physicians for a National Health Program, a grassroots doctors group advocating for a single-payer national health program.