Health Care

Has Kamala Harris Escaped the Medicare-for-All Morass?

Sen. Kamala Harris speaks at the 2019 National Forum on Wages and Working People in Las Vegas, Nev., April 27, 2019. (Gage Skidmore)
Not quite.

Over the past six months, Kamala Harris has tied herself in knots over the issue of Medicare for All. Shortly after launching her presidential campaign, the California senator appeared at a CNN town hall where she indicated she supported getting rid of all private health insurance, just as Bernie Sanders’s Medicare for All bill (of which Harris is cosponsor) would do.

“I believe it will totally eliminate private insurance. So for people out there who like their insurance, they don’t get to keep it?” CNN’s Jake Tapper asked Harris. “Let’s eliminate all of that. Let’s move on,” Harris said.

Harris later backtracked, saying she didn’t support abolishing health insurance because Sanders’s Medicare for All bill still allows “supplemental insurance.”

But “supplemental insurance” was nothing more than a fig leaf: Sanders’s bill explicitly bans private insurance coverage for any service covered by the one-size-fits-all Medicare-for-All system, leaving little more than cosmetic surgery for the private health insurance industry to cover. As the New York Times has noted, cosmetic surgery insurance doesn’t exist, and at “the heart of the ‘Medicare for all’ proposals championed by Senator Bernie Sanders and many Democrats is a revolutionary idea: Abolish private health insurance.”

Harris continued to waffle back and forth between endorsing the abolition of most private insurance and hiding behind the “supplemental insurance” fig leaf. So on Monday, she finally did something politically sensible: She released her own plan that diverges significantly from Sanders’s plan.

Unlike Sanders’s plan, which transitions to a single-payer system in just four years, Harris’s transition would take a full 10 years. “Under my plan, no one will lose access to insurance during a transition. Period,” Harris wrote in a Medium post unveiling her plan.

At the end of the decade-long transition, all Americans would be transferred to a federally administered Medicare plan or to heavily regulated plans, akin to Medicare Advantage, administered by private health-insurance companies.

As a purely political matter, saying she’d allow private plans to compete with Medicare is a better talking point than Harris’s claims about “supplemental insurance.” But it hardly inoculates her from criticism from the left and the right.

Bernie Sanders’s campaign manager, Faiz Shakir, wrote on Twitter: “Let’s take a popular, good government-run program. Add a lot more privatization and profit-seeking into it. What could go wrong?”

“I don’t think she solved the issue of everyone on employer coverage having to migrate to Medicare for All. I think that’s the attack point for Republicans: ‘You’re still ending the employer-based insurance system for 160 million people,’” James Capretta of the American Enterprise Institute tells National Review.

Harris hasn’t turned her outline into a legislative proposal. While she says she’d allow Medicare Advantage-style plans, she also writes that “unlike under the current program, these private Medicare plans will be held to stricter consumer protection standards than they are today, such as getting reimbursed less than what the public Medicare plan will cost to operate, to ensure that they are delivering meaningful value and unable to profit off of gaming consumers or the government.” What other consumer protections will these plans be subject to? What exactly is the advantage of Medicare Advantage? These are questions Harris will have to answer soon.

Another big problem for Harris is that she still doesn’t have a plan to pay for it. “One of Senator Sanders’s options [to help pay for his plan] is to tax households making above $29,000 an additional 4% income-based premium. I believe this hits the middle class too hard,” Harris writes. “That’s why I propose that we exempt households making below $100,000, along with a higher income threshold for middle-class families living in high-cost areas.”

To make up for the revenue lost by not taxing Americans earning less than $100,000, Harris proposes taxing “Wall Street stock trades at 0.2%, bond trades at 0.1%, and derivative transactions at 0.002%” and ending “foreign tax shelters by taxing offshore corporate income at the same rate as domestic corporate income.”

“Together, these proposals would raise well over $2 trillion over ten years, more than enough to make up the difference from raising the middle class income threshold,” Harris writes.

But Sanders notes that a 4 percent tax on all households (including those making $29,000 to $100,000) would raise $3.5 trillion over ten years. Medicare for All would cost $30 trillion to $40 trillion over 10 years. The 4 percent tax is just a down payment. Where does Harris plan on getting the $26.5 trillion to $36.5 trillion to pay for her version of Medicare for All? She doesn’t say.

While there are many questions about her plan, Harris luckily won’t have to endure direct criticism from the leading progressive advocates of Medicare for All on stage at this week’s debate. Bernie Sanders and Elizabeth Warren appear at Tuesday’s debate, while Harris and Biden will be on stage Wednesday night.

Biden campaign official Kate Bedingfield telegraphed the former vice president’s line of attack in a statement Monday: “This new, have-it-every-which-way approach pushes the extremely challenging implementation of the Medicare for All part of this plan ten years into the future, meaning it would not occur on the watch of even a two-term administration. The result? A Bernie Sanders-lite Medicare for All and a refusal to be straight with the American middle class, who would have a large tax increase forced on them.” Whether Biden himself, who appeared unsteady and unsure of himself at the first debate, can prosecute the case against Harris and Medicare for All on Wednesday remains very much in doubt.

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