Mike Segar / Reuters

In the midst of a flurry of health-care-related questions during the second Democratic presidential debate, Joe Biden said something that was either a very strange slip of the tongue or a very bold appeal to voters’ populist rage.

“We can deal with the insurance companies by, No. 1, putting insurance executives in jail for the misleading advertising, what they’re doing on opioids, what they’re doing—paying doctors to prescribe,” the former vice president said in response to a question about whether he would cover undocumented immigrants.

It’s true that there are currently many ongoing lawsuits against drug manufacturers for allegedly sparking the opioid epidemic. Putting pharma-company executives in jail is already a pretty radical—though some would say justified—step. From 1999 to 2017, almost 218,000 Americans died from a prescription-opioid overdose, and some pharma executives have been found guilty of bribing doctors.

But jailing insurance-company executives would be a strange move indeed. Health insurance covers a range of services, and while it technically also does cover opioid medications, insurers haven’t generally pressured doctors to prescribe more opioids, nor have they misleadingly marketed the drugs. That’s all pharma.

It’s possible, perhaps likely, that Biden meant “pharmaceutical-company executives” rather than “insurance-company executives.” If so, that’s a pretty major slip of the tongue, akin to calling to increase student debt rather than wipe it out.

Then again, throughout the Democratic debates most of the candidates have tried to capitalize on the emotional dimensions of health care, how important it can feel to Americans. Several candidates, including Biden, shared personal stories of their own health crises or those of their family. The culprits, according to many of the candidates, are pharmaceutical executives and insurance companies, which they painted as evil and greedy.

Perhaps Biden was simply trying to tap into voters’ indiscriminate outrage over a health-care system that many feel is too exploitative. It might not matter to voters who exactly is held to account—as long as someone is.

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