Kamala Harris' Useless Medicare for All Compromise

After proposing the most complicated student debt relief program in history, Kamala Harris is out with her healthcare plan, which she is describing as Medicare for All despite it not being that. Whatever!

The major difference between her plan and Medicare for All: Private insurers would be allowed to offer Medicare plans, like Medicare Advantage does today. Her plan would also have a 10 year transition period, during which newborns and the uninsured would be enrolled automatically and everyone else could buy into the plan, as opposed to the four year transition period under Sanders’ plan.

That transition is perhaps the weakest part of the plan, but not to hear the think tank set tell it. The New York Times reported that Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, told the paper the 10 year transition was “more realistic” than Sanders’ four-year transition. And Kavita Patel, a Brookings fellow and former Obama official, told HuffPost that it was both more realistic and more “pragmatic”—the two favorite words of the Washington wonk class. The longer the transition, the more realistic it is. Let’s make it 1,000 years, just to be on the safe side. Here I am, demonstrating how pragmatic and sensible I am by increasing the period during which Republicans and the healthcare industry could fight to undo the plan.

The Affordable Care Act delayed Medicaid expansion to 2014, allowing ample time for the Supreme Court to make it optional for states to expand their Medicaid programs, many of which declined to do so—causing thousands of unnecessary deaths. And that was only four years.

There are some key details missing from Harris’ plan, too. She says there will be no deductibles or co-pays, but doesn’t mention whether there will be premiums. She says the plan will have “strong caps on out-of-pocket costs,” but doesn’t say what that would be, or what out-of-pocket costs would remain. And on drug costs, one of the biggest areas of spending for seniors under the current Medicare plan, she only says that she will “empower the Secretary of Health to negotiate for lower prescription drug prices” and perform “a serious auditing of prescription drug costs to ensure Americans aren’t paying more for their prescription drugs than other comparable countries.” Sanders’ plan, by contrast, limits individual drug cost-sharing to $200 per year, or $17 per month.

The other major difference with Sanders’ plan is the continuation of private Medicare plans, like the current Medicare Advantage plans. What is the advantage of allowing private insurers to offer a plan in the Medicare system? Sanders’ plan already allows for private insurance to cover things that aren’t covered by Medicare, if they want to buy those—his bill only bans plans that offer “duplicative coverage.” Why make them part of the Medicare system, allowing them to bilk the government for billions? Medicare Advantage plans today already game the system to receive more money than they should. Harris’ plan claims she would hold these plans to “stricter consumer protection standards.” Is that “realistic,” too?

People don‘t choose private Medicare plans because they’re desperate to receive their insurance from a private company rather than the government. It’s because the current Medicare program costs seniors a lot and doesn’t cover everything—the private plans often cover things like dental and vision, which Medicare doesn’t cover. (This doesn’t mean they’re actually a good deal for seniors, but they’re sold to them as if they are.) The premiums are very low, too—just $28 per month on average. If you structure the Medicare for All program so that those concerns are allayed—for example, by eliminating deductibles or covering drug costs—you don’t need these extra plans.

How do Medicare Advantage plans make their profits with such low premiums? It’s not by being more “efficient” than Medicare—on a practical level, it’s certainly less efficient to add another middleman for payments. Just like regular private insurance, Medicare Advantage denies claims: In 2018, the Department of Health and Human Services reported that 75 percent of denied claims that are appealed under Medicare Advantage are overturned, suggesting that the insurers may have “an incentive to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits.” No shit. (If Harris plans to limit private plan reimbursement, I wonder if they might seek to make up their profits in other ways that have proved effective so far.)

In 2017, the Government Accountability Office also found that 27 percent of the plans they reviewed had disproportionately high numbers of sicker individuals dropping the plan, indicating that those plans might not be providing the care they needed. According to NPR, patients under those plans cited difficulty accessing their preferred doctors as a reason for leaving. (Again, Harris’ plan is not specific about how she would rein in these practices—she just promises that she would.)

In their write-up of Harris’ plan, the New York Times wrote that the preservation of private Medicare plans “could go a long way toward neutralizing fierce opposition from insurance companies.” This is laughable. Even Biden’s plan, a pathetic public option, was attacked by the healthcare industry’s anti-Medicare for All group. (I look forward to Joe Biden and Beto O’Rourke attacking Harris for proposing a system that would cause everyone to lose their plans eventually.)

But that fundamental premise is broken. There should be no role for profit in the healthcare system, and the level of profit that insurance companies currently enjoy—the top insurers raked in more than $7 billion in profits in just one quarter last year—is obscene. They will fight anything that reduces these profits, tooth and nail. Sure, Medicare for All is their nightmare scenario—that’s part of why it’s so good—but the idea that Harris’ plan will neutralize industry opposition is absurd. If insurance companies are OK with it, it’s a bad plan.

You can either take on the insurance industry and protect patients, or you can tiptoe around them and allow them to keep profiting off patients. There’s no middle ground.