Kamala Harris was the big winner overall in Thursday night’s debate, but she also managed to create more confusion over her healthcare position. With her subsequent “clarification,” she has staked out the least defensible ground of any of the 2020 Democratic candidates.
Most of the Democratic field can be divided into two camps. There are those who are unapologetically in favor of ending private insurance that covers 180 million Americans and forcing everybody onto a single government-run plan, and those who believe in creating some sort of optional government-run plan while allowing people to maintain their current coverage.
There’s an argument that can be made in defense of both approaches. That is, you could make the case that it’s inefficient to maintain private insurers — middle men who are sucking money out of the system to rake in profits. Or you could argue for the benefits of limiting disruption by making a government plan optional.
Harris has been trying to have it both ways for months. In a January town hall, the California senator said of private insurance, “Let’s eliminate all of that. Let’s move on.” In May, she claimed that what she really meant was she wanted to move on from all the inefficiency, but that she didn’t support getting rid of private insurance, because she would allow “supplemental” coverage. Her campaign has been trying to advance that distinction, which as I explain below, is highly misleading.
So it surprised many of us when, during the Democratic debate, she raised her hand in what sounded to everybody like a clear question about whether candidates favored getting rid of private insurance for those who currently have it. It seemed like she was returning to her original, unapologetic position, which would be consistent with her support for Bernie Sanders’ plan.
But by Friday morning, she changed again. Harris told Morning Joe that, “the question was, ‘Would you give up your private insurance for that option’ and I said yes.’”
A review of the transcript shows that moderator Lester Holt asked, “Many people watching at home have health insurance through their employer. Who here would abolish their private health insurance in favorite of a government-run plan?”
The context makes it clear, at least to me, that the “their” referred to those who have health insurance through their employer.
Even if we give her the benefit of the doubt that she misheard the question, the implications of her support for the Sanders plan is that it would make all current employer insurance policies illegal. The only answer was “yes” even after having had time to understand the point of the question.
Specifically, the Sanders bill bars private insurers or employers from offering any coverage that covers any of the same benefits as the government plan, which promises to offer a sweeping array of coverage.
It’s right there in Sec. 107 of the bill that Harris co-sponsored: Within four years of enactment, “it shall be unlawful for — (1) a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act; or (2) an employer to provide benefits for an employee, former employee, or the dependents of an employee or former employee that duplicate the benefits provided under this Act.”
If that isn’t clear enough, Sanders himself, the author of the bill, has said repeatedly that it will eliminate private insurance beyond the limited role for private coverage for cosmetic surgery.
Yet Harris is trying to cling to this idea of “supplemental” coverage as if it has any real meaning. When people are concerned about private coverage, what they really care about is whether they’d be able to keep their current health plans. The answer is a clear and unequivocal “no” for any supporter of the Sanders plan, which includes Harris.
“I am a proponent of ‘Medicare for all,’” Harris said on Morning Joe. “Private insurance will exist for supplemental coverage, but under my vision of ‘Medicare for all,’ one, we will expand coverage, so that would include dental, it would include vision, it would include hearing aids, which is a big issue for our seniors and extremely expensive. Also this: listen the insurance companies for years have been putting millions of dollars into an advertising campaign and a lobbyist campaign that is trying to convince American families you need to have your insurance company to have your doctor. Well that’s a myth, and it’s a fallacy — 91% of the doctors in America are in Medicare, so you will not lose your doctor.”
A few things to unpack there. What’s odd is that Harris is slipping in this “supplemental” idea while also making what amounts to a case for getting rid of private insurance. She also talks about how she’s going to expand benefits. But remember, the flip side of expanding benefits is that the more generous the government plan, the narrower the range of supplemental plans that will be legal, since they cannot duplicate coverage.
Furthermore, the 91% statistic applies to the current Medicare program, which exists within a system in which doctors and hospitals can accept less in payments from Medicare, because they can shift costs onto private payers. The Sanders bill would get rid of existing Medicare, and fold everybody onto the new government plan, and so there wouldn’t be anybody to shift costs onto. If government tries to use its leverage to negotiate lower payments, doctors and hospitals could have to shut down. Some doctors would likely pull out of the government plan and simply have people pay privately.
Harris was once again given a chance to be honest when asked to clarify that her position was: “’Medicare for all,’ available to all if they want it, if they have private insurance, they keep it?”
She added, “For supplemental coverage. Otherwise they’re in ‘Medicare for all.’”
The problem Harris has in trying to play this game is that it’s the worst of both worlds. It will allow Republicans to attack her both for wanting to kick 180 million people off of their coverage and for being dishonest about it.