Two big questions for Democrats who support “Medicare for All” are whether they understand how such a system would actually work ― and whether they really support what is arguably its most sweeping and controversial feature.
When it comes to Kamala Harris, the answer to both questions appears to be yes.
Harris, the Democratic senator from California who is now running for president, said during a CNN forum Monday evening that she believes health care should be a right ― and that creating a single, government-run insurance program modeled on Medicare is the best way to achieve that.
Harris’ endorsement of Medicare for All is not a new development. She is among more than a dozen Democratic senators who in, in late 2017, co-sponsored Medicare for All legislation from Bernie Sanders, the independent senator from Vermont and longtime champion of the idea.
Harris reiterated that support just a few weeks ago, in an op-ed for The New York Times.
But the Medicare for All Act of 2017, as the legislation is formally called, envisions some dramatic changes to the U.S. health care system ― including a prohibition on private insurance, except for coverage of services outside the scope of the new government plan.
The new plan would pay for just about every medically necessary service, so that wouldn’t leave much of a role, if any, for private coverage.
So far, it hasn’t been clear whether all of the bill’s co-sponsors, several of whom are running for president or at least thinking about it, really want to see such a wholesale change happen ― or whether their support of the Sanders proposal was simply a way of signaling support for universal health care, which can take many forms and which can include a prominent role for private insurers.
CNN host Jake Tapper asked Harris about this, following an audience question on health care. “For people out there who like their insurance,” Tapper asked, “they don’t get to keep it?”
Harris didn’t flinch. “The idea is that everybody gets access to medical care,” she said, “and you don’t have to go through the process of going through an insurance company, having them give you approval, going through the paperwork, all of the delay that may require.”
“Who of us has not had that situation, where you’ve got to wait for approval and the doctor says well, I’m not sure whether your insurance company is going to cover this,” Harris went on to say. “Let’s eliminate all of that. Let’s move on.”
The new interest in Medicare for All, which has become a top priority for progressive politicians and activists, is a byproduct of several factors ― among them, frustration that the Affordable Care Act, which for all of its success at expanding access to care, has left so many Americans still struggling to pay their medical bills.
Medicare for All holds out the promise of addressing this problem, and finally reaching the elusive goal of universal coverage, by automatically enrolling everybody in the government plan and then using regulation to set prices for doctors, hospitals, and the rest of the health care industry. Typically, such proposals envision people paying for coverage entirely through taxes or income-related premiums, with little or no co-payments, deductibles, and other forms of cost-sharing.
Such a system would likely be a lot easier for patients to use, as Harris suggested, and a lot more straightforward for the providers of health care, as well, because they wouldn’t have to worry about billing so many different insurers. In countries like Sweden and Taiwan, such systems deliver quality care to all residents, at a fraction of what the U.S. spends.
But the transition to the new system could be difficult, depending on the final policy details of legislation. One key factor is how well the new plan would pay doctors and hospitals, and whether they would react by reducing their capacity to see patients.
Whatever the actual merits of the switch away from private insurance, surveys suggest that many Americans who have decent coverage now are nervous about changes. Just last week, a poll from the Henry J. Kaiser Family Foundation found that support for a support for a Medicare for All system dropped dramatically when people learned that it would mean giving up existing insurance, although that was just one of several questions the pollsters tested.
That political vulnerability is one reason some other Democrats have stopped short of endorsing measures like the Sanders bill and instead advocated for schemes that envision less dramatic transformations ― or, at least, much slower ones.
Some of their plans would simply open up existing public programs to new groups of people. An example is legislation co-sponsored by Democratic Sens. Sherrod Brown of Ohio and Debbie Stabenow of Michigan that would allow people 55 and older to sign up for Medicare.
Other proposals envision creating a whole new government-run plan, more similar to the one in the Sanders bill, while still allowing employers to continue offering coverage to employees ― and then giving employees the option of sticking with the company plan or buying into the new public program. A pair of House Democrats, Rosa DeLauro from Connecticut and Jan Schakowsky from Illinois, have put forward such a bill.
Of course, these proposals, like Medicare for All, have policy downsides to go with their upsides, and political weaknesses to go with their strengths.
Back in December, right after the Times op-ed, a senior aide to Harris told HuffPost that she doesn’t oppose more incremental proposals, noting that Harris has also co-sponsored a few of them. The same aide said Harris is open to different ways of achieving universal coverage.
“Medicare for All is her preferred plan but she is also open to looking at others that achieve the same principle where health care is a right for all,” the Harris staffer said. “What she believes is that we need is a system where health care is guaranteed to every American and she will continue to look at proposals that achieve that goal.”
But, the aide said, Harris worked with Sanders on crafting the 2017 bill ― and “believes it is the best solution.”
“You change the politics with a compelling case on the policy,” Sams wrote. “I mean, seriously, only in Washington is decrying insurance companies’ paperwork, approvals, and delays so that EVERYONE GETS INSURANCE COVERAGE considered controversial or risky.”