Medicare for All Prospects in a New Presidential Administration

July 23, 2024

Where Kamala Harris stands on health care issues
The Hill
July 22, 2024
By Nathaniel Weixel

While running against Biden in the 2019 Democratic primary, Harris tried to present herself as someone between moderates like Biden and progressives like Sens. Elizabeth Warren and Bernie Sanders. She endorsed the Medicare for All bill introduced by Sanders, but also backed an array of moderate alternatives, including a “private option” plan that would transition to Medicare for All by allowing private insurance plans to compete with public plans.

Still, experts agree, she Is a staunch supporter of expanding ObamaCare and making health care more affordable for millions of Americans – something that is likely to be one of the biggest health care fights in Congress in 2025.

“Harris’ previous support for Medicare for All with a private insurance option is suggestive of her values, but I doubt it will be a big emphasis for her in the current campaign,” Larry Levitt, executive vice-president for health policy at KFF, said in an email. “I think Harris will lean much more into the Biden-Harris record on health care than policies she proposed in the 2019 primary. The political and policy context have changed quite a bit since 2019.”

 

Comment by: Don McCanne & Jim Kahn

So does Kamala Harris support single payer / Medicare for All strongly enough to move it forward were she elected president? Many politicians include Medicare for All in the list of policies they support, but, after they are elected, it is moved off their desks as they deal with other pressing policies.

We must also note that including a private insurance option has major downsides. First, if private plans recruit and retain lower cost individuals while avoiding costly ones (in geek speak, risk selection), the system might split into a financially challenged public system for the sickest, and a highly profitable private system for the healthier. In addition, the added billing and insurance-related burden on providers and insurer profits would deprive our health care system of the efficiency we need and deserve to cover everyone while still controlling costs. So, from a technical perspective, all-in public insurance is best, as seen in many wealthy nations. Finally, a split system attenuates public insistence on an optimally functioning public system.

There is also an advocacy challenge. The enthusiasm for single payer in 2019, and still today, is high, about 2/3 of adults in fair polling questions. But under assault it is not as robust as we advocates would like. As an example, a panel debate including former PNHP president Adam Gaffney and the Pacific Research Institute’s Sally Pipes showed that, in spite of an excellent presentation by Gaffney, the audience support for Medicare for All declined significantly (YouTube video and transcript). This type of debate + polling is tricky to generalize, but is nonetheless a harbinger of fights ahead of us when single payer is under serious consideration.

We still have a lot of work ahead to persuasively convince the public of the clearcut advantages of properly public health insurance that would provide comprehensive care equitably to absolutely everyone, at a lower cost than the vast majority of us are paying now, thanks to progressive financing. Once these ideas are fully grasped by the public – which then raises voices in unison demanding its enactment and implementation – a President Harris would very likely respond positively.