Charles Gaba is a health-care analyst and founder of ACASignups.net.
After months of confusing statements on the campaign trail, Sen. Kamala D. Harris (D-Calif.) has finally released her proposal to offer comprehensive, universal health-care coverage under the Medicare-for-all brand.
Harris’s rollout Monday was met with swift criticism from both the Biden camp, which called it “A Bernie Sanders-lite Medicare for All,” and the Sanders camp, which insists Harris “can’t call [her] plan Medicare for All.”
In saying this, the Sanders campaign is effectively trying to lay a copyright claim to Medicare-for-all, as if it, and only it, can define what it means. The reality is far less clear — and depending on your perspective, it could be Harris’s proposal that is more justified in claiming the Medicare-for-all branding.
Medicare has historically enjoyed high public approval ratings, which is likely why at least five different health-care expansion bills have been introduced in Congress this year with the “M” word in the title, including “Medicare for All,” “Medicare for America,” “Choose Medicare,” “Medicare X” and “Medicare at 50.” Each would expand the Medicare program to some degree, either in who it covers, what it covers, or both.
But while most people vaguely define Medicare simply as a government health-care program for seniors, there are additional parameters that make Medicare what it is today. First, while Medicare is mostly paid for with federal tax dollars, it also includes cost-sharing through premiums, deductibles, co-pays and coinsurance, just like private insurance policies. Medicare was originally limited to those older than 65 but was expanded to include certain people under 65 with serious disabilities. Congress also added an option, known today as Medicare Advantage that allows Medicare benefits to be administered by private insurance carriers, as well as a program (Medicare Part D) to cover prescription drugs.
In other words, the definition of Medicare has changed several times over the years, which explains why there has been so much confusion over the meaning of Medicare-for-all.
Under Sen. Bernie Sanders’s (I-Vt.) definition, the phrase means that Medicare would be massively expanded to include nearly every medical service under the sun, with every resident of the United States being transferred to it (the exceptions being those covered by the Department of Veterans Affairs or the Indian Health Service). Sanders would also increase the portion of costs covered by the federal government to nearly 100 percent.
While “supplemental” private insurance would be allowed to cover the handful of services not covered by the greatly expanded Medicare program, all private major medical insurance, as well as privately administered variants (Medicare Advantage), would be outlawed after a four-year transition period. Various taxes would be increased significantly to cover the additional costs, which would completely replace existing premiums, deductibles and almost all other types of cost sharing.
But not even all Democrats support this definition. Some people think “for all” means “for all who want it,” allowing private insurance and making participation optional. And others have interpreted Medicare-for-all to simply mean expanding the current program to more people while keeping the existing limitations on covered services, as well as premiums, deductibles and co-pays.
Among these variations, Harris’s plan is the closest to Sanders’s version. But there are three major differences: The Harris proposal has a longer phase-in period (10 years instead of four); a higher threshold for tax increases to pay for it (households earning $100,000 instead of $29,000); and it retains the optional Medicare Advantage plans (as long as those plans are at least as comprehensive as the expanded “standard” Medicare). It’s unclear whether Harris’s version would include premiums after the transition period, but it seems as though those would eventually be eliminated.
Given these facts, the Sanders campaign is wrong to claim Harris’s plan doesn’t represent Medicare-for-all. There is no “one true definition" of the term; as a friend of mine puts it, Medicare-for-all, the brand, isn’t the same thing as Medicare-for-all, the bill.
More importantly, even if you do use the existing program structure as your baseline, Harris’s plan is actually closer to the current definition of Medicare, because it would retain Medicare Advantage. This is no small thing, as more than 22 million people — a third of all Medicare enrollees — have Medicare Advantage plans. In fact, David Bowen, who worked for the late senator Ted Kennedy (D-Mass.), said Harris’s plan “closely resembles” the Medicare-for-all bill that Kennedy and Rep. John Dingell (D-Mich.) introduced in 2006.
There’s plenty of room to question and critique the Harris plan; indeed, many voters would prefer former vice president Joe Biden’s approach to expand on the Affordable Care Act and add a public option, if only in the short term. But don’t fall for arguments that Harris’s plan “can’t be” considered Medicare-for-all; no one has a monopoly on the term.