Which of these Democrats can insure more Americans?
As Wednesday’s debate made vividly clear, there are almost as
many versions of “Medicare for All” as there are Democratic candidates -- and
each one thinks their plan is the path to insuring every American.
For California Sen. Kamala Harris and former Vice President Joe
Biden, health care became the sequel to their first fiery exchange -- when
Harris, peering over at Biden, movingly recalled during the first round of
debates last month how the busing policy he once backed had changed the course
of her life.
This time they were in Detroit, joined for the second night of
this second round of Democratic primary debates by New Jersey Sen. Cory Booker
and seven other presidential hopefuls.
Though only two candidates referenced health care in their
opening remarks -- former Housing and Urban Development Secretary Julian
Castro, who also served as the mayor of San Antonio, Texas; and New York Sen.
Kirsten Gillibrand -- there was another elephant in the room: Medicare for All.
For about 24 minutes, nearly a quarter of the debate, the 10
Democrats wrestled for control of the health care issue. They batted around
arguments for why their version of a government plan would bring Americans
universal health coverage. They cited the hefty profits of the insurance and
pharmaceutical industries as a critical symptom of the system’s ills.
Harris was confident in outlining her Medicare for All plan,
saying she listened to Americans to create an approach that would respond to
their needs. This would include a public option and a 10-year transition to a
new Medicare-based system.
But Biden quickly hit back, saying that when someone promises
something in 10 years, you have to wonder why it will take so long. He
reiterated his support for the Affordable Care Act, saying it is working and
the best way forward is to “build on what’s working.”
They bickered over how to retain choices for consumers, using
terms like private and employer-based insurance, public option and Medicare
Advantage.
New York City Mayor Bill de Blasio puzzled over the “mythology
that people are in love with their private insurance.” Washington Gov. Jay
Inslee boasted that his state just became the first to provide its citizens
with a public option. Biden boldly repeated his version of a claim very similar
to the one that once earned President Barack Obama PolitiFact’s 2013 Lie of the
Year.
At times the back and forth was fast and furious, and it seemed
even the candidates were lost in the numbers they were firing across the stage.
Fortunately, we were taking notes.
HARRIS: “I’m going to go back to Vice President Biden because
your plan does not cover everyone in America by your staff’s and your own
definition. Ten million people, as many as 10 million people, will not have
access to health care.”
Her claim needs, at least, further scrutiny.
When Biden unveiled his health care plan a couple weeks ago, his
campaign noted -- under the bold heading, “Give Every American Access to
Affordable Health Insurance” -- that it would insure “more than an estimated 97
percent of Americans.”
Vermont Sen. Bernie Sanders, who is also running for the
Democratic presidential nomination, first proposed the Medicare for All plan.
His campaign initially seized on that figure on Monday, arguing that that would
leave about 10 million people uninsured.
A Harris campaign spokeswoman pointed to the fact that there are
an estimated 329.3 million people in the United States, and 3% of the total
population would be about 9.88 million people.
Imprecise math aside, there are other factors that could play
into the number of uninsured individuals under a Biden health care system. That
includes the fact that some Americans just don’t want insurance -- the problem
the Affordable Care Act’s individual mandate was intended to fix. But
Republicans in Congress repealed the penalty for that mandate.
SEN. MICHAEL BENNET: “I believe we should finish the job we
started with the Affordable Care Act with a public option that gives everybody
in this audience the chance to pick for their family whether they want private insurance
or public insurance and requires drug companies to be negotiated with by
Medicare and it provides competition. That is totally different from the plan
that Sen. Warren and Sen. Sanders and Sen. Harris have proposed, which would
make illegal employer-based health insurance in this country.”
Both Bennet and Biden claimed Harris’ plan would lead to the
elimination of employer-based insurance. That could be the case, particularly
for plans that would not meet the expansive requirements for coverage of
“medically necessary” services Harris outlined.
But there is more to learn about Harris’ plan, released just two
days ago -- and at least a couple problems with Bennet’s claim.
To start, while Warren, Sanders and Harris all use the term
“Medicare for All” to refer to their preferred health care plan, they do not
share a single plan.
The Sanders plan (endorsed by Warren) would eliminate private
insurance in favor of a government plan. Harris’ plan, though, keeps a role for
private insurers willing to offer Medicare coverage that meet certain benefit
and cost requirements.
During her plan’s decade-long phase-in, Harris wrote in a Medium
post -- and Bennet’s campaign cited as evidence -- that it would “provide a
commonsense path for employers, employees, the underinsured, and others on
federally-designated programs, such as Medicaid or the Affordable Care Act
exchanges, to transition.”
Would those employer plans transition out of existence? Harris’
campaign did not immediately respond to inquiries about the future of
employer-based insurance under her proposal.
___
(c)2019 The Philadelphia Inquirer
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