Among Democrats, a de­bate over ‘Medi­care-for-all’

Sin­gle-payer plans are at­trac­tive but the op­tions and eco­nomic chal­lenges are daunt­ing


WASH­ING­TON — “Medi­care­for-all” is quickly be­com­ing a ral­ly­ing cry for many Demo­cratic White House hope­fuls, but ques­tions are grow­ing over how to pull off such a dra­matic switch to a gov­ern­ment-run health care sys­tem.

The de­bate over scrap­ping pri­vate in­sur­ers has heated up in re­cent days since Demo­cratic Sen. Ka­mala Har­ris of Cal­i­for­nia, a sup­porter of “Medi­care-forall,” told CNN’s Jake Tap­per, “Who of us has not had that sit­u­a­tion, where you’ve got to wait for ap­proval, and the doc­tor says, ‘Well, I don’t know if your in­sur­ance com­pany is go­ing to cover this’? Let’s elim­i­nate all of that. Let’s move on.”

But since her na­tion­ally tele­vised re­marks, sev­eral of Har­ris’ ri­vals have point­edly spo­ken about their plans to work to­ward uni­ver­sal health care in more prag­matic, in­cre­men­tal ways. Those Democrats por­tray the sin­gle-payer health care pro­posal they’ve backed as only one strat­egy to achieve uni­ver­sal cov­er­age, while em­pha­siz­ing the im­por­tance of other, less sweep­ing paths.

Among the skep­tics, for­mer New York Mayor Michael Bloomberg has said “Medi­care-for-all” would “bank­rupt for us for a very long time.”

Unit­ing Democrats is a de­sire to guar­an­tee cov­er­age for all, in­clud­ing an es­ti­mated 29 mil­lion peo­ple who re­main unin­sured. Some are back­ing a plan that would let peo­ple buy into Medi­care, with tax cred­its from the Obama-era Af­ford­able Care Act.

At the fore­front of the de­bate is Ver­mont in­de­pen­dent Sen. Bernie San­ders’ “Medi­care-for-all” bill, which holds out the prom­ise of health care as a right, the po­ten­tial for na­tional sav­ings from re­duced ad­min­is­tra­tive costs and gov­ern­ment price-set­ting, and no more co­pays, de­ductibles or sur­prise med­i­cal bills. His plan en­vi­sions a four-year tran­si­tion, phas­ing in the change by age groups. Si­mul­ta­ne­ously, some big tax in­creases would be tak­ing ef­fect.

But there would be enor­mous chal­lenges to put in place a sin­gle-payer health in­sur­ance with the gov­ern­ment fully in con­trol of the $3.5 tril­lion U.S. health care sys­tem, ex­perts say. And polls show a loom­ing po­lit­i­cal prob­lem be­cause many peo­ple don’t yet re­al­ize it would mean giv­ing up their pri­vate cov­er­age. An­other is­sue: San­ders’ of­fice says his plan would cover abor­tion, a ma­jor change from cur­rent fed­eral laws and policies.

In ad­di­tion to Har­ris, Demo­cratic Sen­a­tors Cory Booker of New Jer­sey, Kirsten Gil­li­brand of New York, and Elizabeth War­ren of Mas­sachusetts have signed onto the San­ders bill.

Gil­li­brand, who crafted lan­guage in San­ders’ bill that al­lows peo­ple to buy non­profit in­sur­ance cov­er­age dur­ing the tran­si­tion, em­pha­sized the im­por­tance of

that bridge.

“If more peo­ple buy into Medi­care over what­ever your tran­si­tion pe­riod is, you will dis­rupt the in­sur­ance mar­ket be­cause you’ve cre­ated more com­pe­ti­tion for lower prices and qual­ity care,” Gil­li­brand told The Associated Press.

“What I like about where the Democrats are to­day is, we have four or five ver­sions of ‘Medi­care-for-all’,” she added. “I think we all want to get to sin­gle payer. And I think the best way to do it is what I wrote in Sen. San­ders’ bill.”

Booker, who de­clared his own can­di­dacy on Feb. 1, told a satel­lite ra­dio show that day that he is “a big be­liever in ‘Medi­care-for all’— but I be­lieve that if we give peo­ple a qual­ity pub­lic op­tion, we’re go­ing to be able to get more peo­ple into the sys­tem.”

And War­ren, for her part, told Bloomberg TV last week that “mul­ti­ple bills on the floor in the United States Se­nate” would ac­com­plish her core pri­or­ity of en­sur­ing that “ev­ery Amer­i­can has health care at a price they can af­ford.”

Sens. Amy Klobuchar of Min­nesota and Sher­rod Brown of Ohio also de­scribe uni­ver­sal health care as an ul­ti­mate goal, but nei­ther has signed onto San­ders’ leg­is­la­tion. Brown has called for the ex­pan­sion of Medi­care to those over 50 as a more work­able first step, while Klobuchar said in a re­cent in­ter­view that “on health care, there’s a lot more that unites us in the Demo­cratic Party.”

“One, we do not want to re­peal” Oba­macare, she added. “Two, we want to ex­pand Med­i­caid. Three, we want to im­prove on that as well as get to uni­ver­sal cov­er­age.”

Oth­ers are less san­guine about a sin­gle-payer ap­proach. “We can’t pay for it, it elim­i­nates choices, most ver­sions … would make pri­vate health care cov­er­age for al­most all health care needs il­le­gal, and it will di­min­ish qual­ity and ac­cess,” said for­mer Mary­land Rep. John De­laney.

Among non-can­di­dates, Kath­leen Se­be­lius, for­mer Health and Hu­man Ser­vices sec­re­tary un­der Pres­i­dent Barack Obama, said Democrats should de­bate a full range of op­tions.

“I think this is a great op­por­tu­nity to put plans on the ta­ble and hope­fully not have an early lit­mus test that says we only want to talk about one idea,” said Se­be­lius. “I want to talk about 15 ideas.”

Now re­tired from po­lit­i­cal of­fice, for­mer Demo­cratic con­gress­man Jim McDer­mott of Wash­ing­ton said, “A sin­gle-payer sys­tem would be best if we had a magic wand, but, in the real world, it is go­ing to be ex­traor­di­nar­ily dif­fi­cult to make this change.”

The last in­dus­tri­al­ized na­tion to tran­si­tion to a sin­gle-payer sys­tem was Tai­wan in 1995. Prince­ton health pol­icy an­a­lyst Tsung-Mei Cheng, who stud­ied the Tai­wan ex­pe­ri­ence, said she be­lieves the Demo­cratic can­di­dates are do­ing poorly ex­plain­ing pros and cons.

“I don’t think that the full in­for­ma­tion that would re­ally help vot­ers is out there,” she said. “You need to of­fer more specifics, and first of all about fi­nanc­ing.”

Sen. Ka­mala Har­ris

Sen. Bernie San­ders

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