Some no longer all-in on health plan

Sev­eral Demo­cratic hope­fuls have pulled back from sup­port­ing ‘Medi­care for All’

The Morning Call - - NATION & WORLD - By Chelsea Janes and Michael Scherer

U.S. HIGH­WAY 20, Iowa — Lean­ing back on a black leather sofa as her cam­paign bus rum­bled to­ward Fort Dodge, Sen. Ka­mala Har­ris tried to ex­plain why she spent months de­fend­ing a plan to re­place pri­vate health in­sur­ance with “Medi­care for All,” only to switch to a more mod­est pro­posal that would al­low pri­vate in­sur­ance to con­tinue af­ter all.

“I don’t think it was any se­cret that I was not en­tirely com­fort­able — that’s an un­der­state­ment,” Har­ris said. “I fi­nally was like, ‘I can’t make this cir­cle fit into a square.’ I said: ‘We’re go­ing to take hits. Peo­ple are go­ing to say she’s waf­fling. It’s go­ing to be aw­ful.’ ” But, she said, she de­cided it was worth it.

The Demo­cratic se­na­tor from Cal­i­for­nia is hardly alone. The idea of Medi­care for All — a uni­fied govern­ment health pro­gram that would take over the ba­sic func­tion of pri­vate in­sur­ance — be­came a lib­eral lit­mus test at the out­set of the pres­i­den­tial cam­paign, dis­tin­guish­ing Demo­cratic con­tenders who cast them­selves as bold vi­sion­ar­ies from more mod­er­ate prag­ma­tists.

But in re­cent months, amid polling that shows con­cern among vot­ers about end­ing pri­vate in­sur­ance, sev­eral of the Demo­cratic hope­fuls have shifted their po­si­tions or their tone, mod­er­at­ing full-throated en­dorse­ment of Medi­care for All and adopt­ing ideas for al­low­ing pri­vate in­sur­ance in some form.

“What I think has hap­pened in the Demo­cratic pri­mary is peo­ple rec­og­nize that some of the con­cerns about sin­gle-payer are not com­ing from spe­cial in­ter­ests but the pub­lic,” said Neera Tan­den, a for­mer top aide to Hil­lary Clin­ton and now pres­i­dent of the Cen­ter for Amer­i­can Progress. (A govern­ment-run health sys­tem is some­times called a sin­gle-payer sys­tem.)

Har­ris’ new plan would al­low pri­vate in­sur­ance poli­cies as long as they fol­lowed Medi­care’s rules on qual­ity and price, giv­ing con­sumers a choice much like the one se­niors cur­rently have be­tween Medi­care and Medi­care Ad­van­tage plans.

For­mer Texas con­gress­man Beto O’Rourke, who in 2017 em­braced Medi­care for All as the “best way,” now sim­i­larly sup­ports a plan that would pre­serve the cur­rent em­ployer­based in­sur­ance sys­tem.

This un­mis­tak­able, if some­times sub­tle, shift in tone stems in part from Democrats’ fear of giv­ing away a new­found ad­van­tage over Repub­li­cans on health care.

Af­ter the Af­ford­able Care Act passed in 2010, Repub­li­cans scored ma­jor po­lit­i­cal vic­to­ries by vow­ing to re­peal the ini­tially un­pop­u­lar law. But when the GOP seized con­trol of Wash­ing­ton un­der Pres­i­dent Trump and tried to fol­low through on those prom­ises, they faced a pow­er­ful back­lash from vot­ers who’d come to rely on the ACA.

Now some Democrats warn of the perils for their party in tak­ing a po­si­tion that, to im­por­tant groups of vot­ers, could seem just as dis­rup­tive as the GOP’s push to kill the ACA.

“There is noth­ing more per­sonal to peo­ple than their health care,” said Kath­leen Se­be­lius, who con­sulted on Har­ris’ plan and served as health and hu­man ser­vices sec­re­tary in the Obama ad­min­is­tra­tion. “Any­thing that calls for the vast ma­jor­ity of Amer­i­cans to lose what they have — that’s a very dan­ger­ous place to start a con­ver­sa­tion.”

Five of the seven U.S. sen­a­tors in the race have co-spon­sored the Medi­care for All bill drafted by Sen. Bernie San­ders, I-Vt. But they have be­gun to shade their mes­sages, sug­gest­ing that the bill rep­re­sents a long-term vi­sion rather than an im­me­di­ate plan.

Many of the can­di­dates are now fo­cus­ing on steps they say would push the coun­try closer to uni­ver­sal health care with­out a ma­jor dis­rup­tion, such as cre­at­ing a “pub­lic op­tion” that would let peo­ple join Medi­care with­out mak­ing it manda­tory.

Sen. Cory Booker of New Jer­sey, for ex­am­ple, co-spon­sored the San­ders bill and em­pha­sizes that he still sup­ports it, but he de­scribes him­self as a “prag­ma­tist” who would fo­cus on “the im­me­di­ate things we would do,” which do not in­clude elim­i­nat­ing pri­vate health in­sur­ance.

Many Democrats ar­gue that if Amer­i­cans are given the choice of a pub­lic, govern­ment-run health op­tion like Medi­care, they will even­tu­ally see it as prefer­able to the pri­vate sys­tem and will mi­grate there on their own. That would cre­ate a govern­ment-run sys­tem with­out co­erc­ing peo­ple to join it, they say.

Sen. Kirstin Gil­li­brand of New York, an­other co-spon­sor of San­ders’s bill, stresses this ap­proach. “I can go to any­where in this coun­try and say, ‘Why not have a not-for-profit pub­lic op­tion that com­petes with your in­surer charg­ing you too much money?’ ” Gil­li­brand said Mon­day dur­ing a Wash­ing­ton Post Live event.

Even Sen. El­iz­a­beth War­ren of Mas­sachusetts, who de­clared “I’m with Bernie on Medi­care for All” at the first Demo­cratic de­bate, has given her­self wig­gle room, say­ing that “there are a lot of dif­fer­ent path­ways” to achiev­ing the goal of the San­ders bill.

San­ders him­self is em­pha­siz­ing his con­tin­ued al­le­giance to a sweep­ing ver­sion of Medi­care for All. That shows, he sug­gests, that he is the only can­di­date who can be trusted to fight for real change.

His cam­paign ar­gues that al­low­ing pri­vate in­sur­ance to re­main, with all its in­equities and priv­i­leges, would only per­pet­u­ate a tiered health care sys­tem.

SALWAN GE­ORGES/WASH­ING­TON POST

Sen. Ka­mala Har­ris, sec­ond from the right, last week in Iowa. She has al­tered her health care pro­posal to in­clude pri­vate in­sur­ance.

PAUL SANCYA/AP

Sen. Bernie San­ders and Sen. El­iz­a­beth War­ren at the July 30 de­bate in Detroit.

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