Nixing private insurance divides 'Medicare for All' candidates
BY NATHANIEL WEIXEL - 07/02/19 06:00 AM EDT 614
Some Democratic presidential candidates who say they support “Medicare for All” are walking a tightrope on whether to fully embrace a key portion of the proposal that calls for eliminating private insurance.
Only a few White House hopefuls raised their hands when asked at last week’s debates if they were willing to abolish private insurers, even though others who were on the stage have publicly backed legislation from Sen. Bernie Sanders (I-Vt.) which would do just that.
Sen. Elizabeth Warren (Mass.), Sen. Kamala Harris (Calif.) and Sanders all raised their hands, as did New York City Mayor Bill de Blasio. But Harris later said she misunderstood the question, and clarified that she does not support eliminating private insurance.
“I am supportive of Medicare for All, and under Medicare for All policy, private insurance would certainly exist for supplemental coverage,” she said Friday morning on CBS News.
Sanders’s plan would cover every medically necessary service, including dental, vision and long-term care for people with disabilities.
That leaves little room for private insurers to cover anything except cosmetic surgery, Sanders has said.
Harris has seized on that exception to argue Medicare for All wouldn't eliminate private insurance, and that “supplemental coverage” would still exist.
Her comments, along with the discrepancy between those who have supported the Sanders bill on and off the debate stage, illustrate the delicate balance some Democrats are trying to achieve: They want to highlight their progressive chops by talking about Medicare for All, even though much of the voting public isn’t ready to give up their private insurance.
Harris has waffled on the issue of private insurance for months, despite being a co-sponsor of Sanders’s legislation. But she isn’t the only candidate in this situation.
Among the 2020 Democratic candidates, Sens. Cory Booker (N.J.) and Kirsten Gillibrand (N.Y.) are co-sponsors of Sanders’s bill, while Reps. Tulsi Gabbard (Hawaii), Tim Ryan (Ohio) and Eric Swalwell (Calif.) are co-sponsors of a similar House bill introduced by Rep. Pramila Jayapal (D-Wash.), a co-chair of the Congressional Progressive Caucus.
Booker said he thinks there is a role for private insurance, and told The New York Times in a recent candidate survey that he would pursue a public option.
During the debate, Booker was less clear about his plans.
“We have to do the things immediately that provide better care,” he said. “We can do this better, and every single day I will fight to give people more access and affordable cost until we get to every American having health care.”
In a statement after last week’s debates, Sanders said there can be no middle ground, and his campaign called on all the candidates to unequivocally say where they stand on Medicare for All.
"If you support Medicare for All, you have to be willing to end the greed of the health insurance and pharmaceutical industries. That means boldly transforming our dysfunctional system by ending the use of private health insurance, except to cover non-essential care like cosmetic surgeries," Sanders said. "And it means guaranteeing health care to everyone through Medicare with no premiums, no deductibles and no copays."
Democrats are trying to coalesce around a single health care message, much like they did in 2018 to take back the House.
Some on the left maintain that backing Medicare for All legislation is a must for anyone who wants to secure the Democratic presidential nomination next year, but moderate candidates are wary of giving President Trump and Republicans an opening to accuse Democrats of pushing for a “socialist” takeover of health care.
Polls show that voters like the idea of Medicare for All, though most don’t know that the legislation would eliminate private insurance.
A June survey by the Kaiser Family Foundation found that despite what the authors of two Medicare for All bills in Congress have said, a majority of poll respondents thought they would still be paying premiums, deductibles and co-pays.
A similar Kaiser poll from January found that support for Medicare for All dropped from 56 percent to 37 percent when respondents were told it would eliminate private health insurance.
Robert Blendon, a health policy professor at Harvard University, said most candidates will be deliberately vague about Medicare for All, even the ones who are co-sponsors of the Sanders bill.
“I think many candidates signed onto the principle,” Blendon said. “They want a Medicare dominated system but didn’t fully understand that today’s Medicare … has a private alternative which is very popular. I just don’t think they are aware of that.”
Candidates like Sanders, who has been advocating for single-payer for years, understand the nuances, Blendon said, but most others are new to the debate.
“They wanted to show they are committed to moving the country … and now this issue has surfaced in the primary, and it will definitely surface in the general election about a private alternative if you want one,” Blendon said.
Before last week’s debate, Warren had drawn some criticism from the left for equivocating about her health care policy. But on Wednesday, she left no doubt about her position, and made an aggressive play for the progressive vote.
“I’m with Bernie on Medicare for All,” Warren said on the debate stage. She added that politicians who say Medicare for All isn’t feasible just aren’t willing to fight for it.
Warren’s shift puts pressure on Sanders, and was praised by progressive groups.
“When it mattered most, and with millions of people watching, she made the strongest case yet,” said Adam Green, co-founder of the Progressive Change Campaign Committee.
“There’s a huge difference between checking a box on a position, versus actually making the case for the public and persuading them you are right,” Green added. “If all you do is check a box, you aren’t prepared with strong rebuttals to the obvious Republican attacks.”
But Warren’s embrace of Medicare for All also makes her a prime target for attacks from Trump and his GOP allies. Trump has relished attacking Medicare for All, and brought it up again last week, unprompted, as he signed an executive order about health cost transparency.
“More than 120 Democrats in Congress support Bernie Sanders’s socialist takeover of American healthcare. It’s very dangerous,” Trump said. “The Democrat plan would terminate the private health insurance of over 180 million Americans who are really happy with what they have.”
Democratic candidate Sen. Amy Klobuchar (Minn.) touched on those attacks during the debate. She supports a Medicare public option, but is not a co-sponsor of the Medicare for All bill.
“I am just simply concerned about kicking half of America off their health insurance in four years, which is what this bill says,” Klobuchar said.
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