Dem candidates still unclear on health care reform
Health care is voters’ greatest concern. Democrats risk losing the forest through the trees — not to mention the general election — if they fail to emphasize what their plans have in common and to distinguish them articulately.
Better late than never, the second debates flagged that the term “Medicare for All” is used for several different policies. Bernie Sanders’ and Elizabeth Warren’s plan is truest to the term. It proposes a tax-financed single-payer system eliminating most private health insurance.
Other candidates (including Pete Buttigieg, Kamala Harris and Julian Castro) propose changing the Sanders/ Warren plan to allow the choice of keeping private employer-sponsored insurance: “Medicare-for-Allwith-Private- Option.”
Candidates who oppose the term Medicare for All (including Joe Biden, Amy Klobuchar, Beto O’Rourke, Michael Bennet and Steve Bullock) embrace a strengthening and expansion of Obamacare. Their expansion would be a public option for non- elderly to buy into Medicare or another public plan. Unlike the narrower public option that failed to pass in the original Obamacare, which was intended only for those lacking employer-sponsored plans, this thicker public option would also compete with employer-sponsored plans.
If you wonder what the difference is between Obamacarewith-Public- Option and Medicare-for-All-with-Private- Option, you are paying attention.
The biggest question is: What do the Democrats have in common? Failing to answer risks turning what should be their biggest opportunity into a liability. Three commonalities require emphasis:
1) All issue a moral call for health reform to achieve universal coverage for all Americans.
2) All recognize that having insurance is no longer the key to affordability. Health care has become unaffordable to many with insurance, given relentless increases in out- of-pocket costs. Reform must address not only insurance, but cost and value.
3) All believe that increasing availability of a public plan will improve access and reduce costs for many Americans.
Emphasizing those core commonalities should preface discussion about differences. Discussion of differences should leave behind loose labels — especially the overworked analogy to Medicare that has given us no less than five different proposals with “Medicare” in the name. What does the plan look like? Does the proposer view it as a new single-payer system, a transition to a single-payer system or a long-term hybrid solution?
Candidates must answer legitimate questions about transition. Harris deserves the suspicion generated by her proposed 10-year transitional time frame, more than two full presidential terms. But suspicion is also due those who fail to address transition, notably Sanders and Warren. Do they think the half-million Americans who would lose jobs with the elimination of the private insurance sector under their plan, or those who would lose negotiated health benefits beyond the new universal benefit package, should be compensated? By refusing to address transitional issues in their proposed one-time overhaul, they lose an opportunity to invite comparable critical attention to the high cost of incremental change. Often that cost remains untallied because of prevalent, but historically unsubstantiated, assumptions that incremental change is always better.
Here is a suggested first response to questions on health care reform: “It is important to understand all of us Democratic candidates believe we must ensure all Americans stable, affordable health insurance coverage. And all of us agree that widening access to a public plan would help achieve that. Among us are significant differences about means to get there and transitional issues. Let’s talk about those. ...”
Forest first. Then trees. Or sacrifice another chance to improve health care access, value and quality. Or sacrifice the general election to inarticulate bickering in the primary process.