The second round of Democratic presidential debates is upon us, and healthcare policy is likely to be one of the most contentious issues discussed.
For this list, Grit Post is only considering candidates who have a reasonable expectation to be the nominee, based on polling numbers and fundraising data. Because Vice President Joe Biden, South Bend Indiana mayor Pete Buttigieg, and Senators Kamala Harris (D-California), Bernie Sanders (I-Vermont), and Elizabeth Warren (D-Massachusetts) are the far-and-away leaders in those categories, we’ll focus exclusively on their healthcare proposals, as well as that of President Trump, given that he’s expected to best former Massachusetts Governor Bill Weld (R) in the Republican primary.
Joe Biden’s Healthcare Policy
The former vice president rolled out a plan that would essentially leave the status quo in place, but would “uncap” federal assistance toward paying private health insurance premiums. According to NPR, the Biden plan would make sure that no American would have to pay more than 8.5% of their incomes for health insurance. Biden’s healthcare policy platform would also include a “public option” on the health insurance market that would be cheaper than private plans. The Biden campaign estimates the plan would cost roughly $750 billion over a decade.
However, a 2013 Congressional Budget Office evaluation of a public option found that premiums would only be “7 percent to 8 percent lower” on average. As Splinter‘s Libby Watson wrote in February, that would only equal roughly $40 in monthly savings according to the second-cheapest silver plan on her state’s health insurance exchange, “or a couple of pizzas in New York.”
The Biden campaign recently published a video of a retired union worker repeating Biden’s attack on “Medicare for All” policies, erroneously insinuating that Medicare for All would result in millions of Americans losing their health insurance (as Grit Post previously reported, Sanders’ Medicare for All legislation would transition Americans over to a single-payer system over a four-year period, during which a public option would remain available).
Like so many other Americans, Marcy prefers to keep her private insurance while recognizing that a public health insurance option is necessary for some of her friends and family. pic.twitter.com/1PnfSGC5WC
— Joe Biden (@JoeBiden) July 26, 2019
This line of attack is remarkably similar to President Trump’s rhetoric about Medicare for All. In a 2018 op-ed for USA Today, the president falsely stated that Democrats wanted to “end Medicare as we know it” and “gut Medicare for their planned government takeover of American health care.”
“In practice, the Democratic Party’s so-called Medicare for All would really be Medicare for None. Under the Democrats’ plan, today’s Medicare would be forced to die,” Trump wrote.
For his part, Biden defended his healthcare plan in a similar fashion, saying “if you like your employer-based insurance, you get to keep it,” while incorrectly stating that Sanders’ plan would mean “you lose it, period.”
Pete Buttigieg: “Medicare for All Who Want It”
Pete Buttigieg has called for “Medicare for All Who Want It,” as opposed to more ambitious “Medicare for All” plans. In an interview with ABC, the South Bend mayor suggested that while single-payer healthcare would be an ideal final goal, his plan would involve making a public option available, allowing Americans to buy into Medicare.
Despite his promise that the end goal of his plan would be a single-payer system, Buttigieg has more recently attacked Medicare for All, calling the plan “pretty far out… from where Americans are.” It’s worth noting that earlier this year, a Harvard/Harris poll found that 68% of Americans felt a “taxpayer-funded national [healthcare] plan like Medicare for All” should be a top priority of the 116th Congress.
On his campaign website, Buttigieg reiterates his belief in the free market, stating “competition will create the glide path toward Medicare for All.” His website is light on details, but Buttigieg promises his plan would “improve health equity, invest in maternal and infant health, lower drug prices, make long-term care affordable, invest resources in mental health,” and “Combat the opioid and methamphetamine epidemics.”
Assuming his public option would operate the same way as Biden’s proposed public option, the plan would cost $75 billion a year and lower monthly premiums by anywhere between 7% and 8% on average.
Kamala Harris’ Healthcare Plan
Sen. Harris rolled out her healthcare plan just before the debates, attracting both praise and criticism. If Harris’ plan became law, Medicare plans would essentially be offered by private health insurers, who would be required to abide by a set of Medicare standards put in place by her administration’s Department of Health and Human Services. The Harris plan would be phased in under a 10-year period, meaning it could potentially be sabotaged by her successor, either four years after its passage and her exit from office, or eight years after.
According to the New York Times, Harris’ Medicare for All plans would be “modeled on Medicare Advantage,” which is supplemental coverage for seniors offered by private insurance companies in addition to Medicare. But according to an NPR report from earlier this month, those types of plans have overbilled Medicare to the tune of $30 billion in just the last three years.
In order to pay for her plan, Harris would exempt households making less than $100,000 from any tax increases, and would instead institute a Financial Transaction Tax on stocks, bonds, and derivatives as a funding mechanism. Sen. Sanders has proposed a similar funding mechanism for his tuition-free college and student debt forgiveness plans, though Sanders states his financial transaction tax would only bring in about $2.4 trillion over ten years (not even 10% of Medicare for All’s estimated cost).
Harris’ plan was criticized by the Biden campaign as “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 with this plan.” Sanders’ campaign manager, Faiz Shakir, said Harris was “folding to the interests of the health insurance industry” in her plan.
Bernie Sanders’ Single-Payer, Medicare for All Plan
Sen. Sanders is the brainchild of “Medicare for All,” having run on the policy in his 2016 presidential campaign and introducing multiple Medicare for All bills in the Senate. The plan he’s running on in 2020 would institute a single-payer healthcare system that would cover all Americans’ primary care, hospital stays, prescription drugs, and long-term care for seniors.
Over a four-year period, Sanders would gradually lower the Medicare eligibility age, and immediately make a “Medicare Transition” insurance plan available to all Americans. By the fourth year, Medicare eligibility would be for all ages, and private health insurance companies would be rendered obsolete, as the government would already provide healthcare for all Americans as a fundamental right.
As the Koch-funded Mercatus Center found in a 2018 study, the cost of Sanders’ Medicare for All plan would be around $32.6 trillion over a ten-year period, which is actually lower than the approximately $35 trillion per-decade figure that America currently spends on healthcare. While Sanders has said Americans’ taxes would slightly increase to pay for single-payer healthcare, households would still see a significant net savings, as Americans would no longer be required to pay monthly premiums, expensive deductibles, and other significant out-of-pocket costs that come with private health insurance.
Elizabeth Warren’s Healthcare Policy: “I’m With Bernie”
Sen. Warren, who is seen as Sanders’ most progressive rival in the 2020 field, was the only one to raise her hand alongside New York City mayor Bill de Blasio (currently polling at less than 1%) at last month’s debates when moderators asked who would be in favor of replacing private health insurance with a single-payer system.
“I’m with Bernie,” Sen. Warren stated.
Warren is an original co-sponsor of Sen. Sanders’ Medicare for All bill in the Senate, suggesting her position has been consistent. However, her support of single-payer healthcare was in question prior to the first debates in Florida last month, when she told the New York Times “Medicare for All has a lot of different paths.” And socialist magazine Jacobin noted that, while Warren prides herself as a deeply knowledgeable policy wonk on seemingly every issue (her motto is “I have a plan”), she’s been noticeably silent on her plans for changing America’s healthcare system:
It’s fair to ask why Warren, who supports bold, progressive policies on a number of major issues, is avoiding the most important issue to voters. It could be a reluctance to attach herself to a rival candidate’s signature policy, or it could be a way to avoid conflict with the powerful health care corporations in her home state of Massachusetts.
Either way, it meshes well with a years-long effort by Democrats to blur the meaning of Medicare for All by gesturing goodwill toward single-payer advocates while attempting to redefine the phrase and apply it to public option proposals that preserve the private insurance industry. By following this playbook, Warren is actively supporting the corporate effort to kill the growing Medicare for All movement.
Indeed, Sen. Warren’s website lists numerous detailed policy proposals, from cancelling student debt, to breaking up big tech companies, to expanding rental housing, to implementing universal child care, and taxing high-net worth individuals to pay for her plans. However, nowhere on the “Issues” page of her website does she ever mention healthcare. It’s safe to assume, unless she states otherwise, that Warren’s healthcare proposal is to pass Sanders’ plan.
President Trump’s Healthcare Policy: No Single-Payer, No Public Option
If you believe President Trump’s 2018 op-ed, health insurance premiums have gone down during his time in office. However, Investopedia’s analysis states that premiums have actually increased by as little as 1%, and as much as 8.4%.
Trump failed in his initial quest to repeal the Affordable Care Act (Obamacare) in 2017, despite Republicans controlling both houses of Congress. Senators Susan Collins (R-Maine), John McCain (R-Arizona), and Lisa Murkowski (R-Alaska) prevented Republicans from securing a majority vote in the Senate. However, the administration appears set on making Obamacare die a death by a thousand cuts.
The Center on Budget and Policy Priorities has kept a timeline of all the policies the Trump administration has put in place to sabotage the Affordable Care Act, from his tax plan’s elimination of the individual mandate (which keeps the risk pool larger, and thus keeps premiums from increasing too much year-over-year) to allowing Republican-controlled states to have waivers on expanding Medicaid, as was done under the Affordable Care Act.
Because Trump has not endorsed a single-payer plan or a government-funded public option, it’s safe to assume his healthcare policy is to allow private health insurers to maintain a monopoly on the American healthcare system.
Carl Gibson is a politics contributor for Grit Post. His work has previously been published in The Guardian, The Washington Post, The Houston Chronicle, Al-Jazeera America, and NPR, among others. Follow him on Twitter @crgibs or send him an email at carl at gritpost dot com.