LAST WEEK’S Democratic presidential debates underscored health care as a defining policy division among the candidates. On one side, many of those who argue for radical change would tell you, are Democrats who want to preserve a status quo in which private companies suck profits out of sick and vulnerable people. Their alternative is killing off the insurance companies and providing universal, high-quality, government-controlled care.
The description is simplistic. The Democratic field is unanimous in its desire to provide universal coverage; the candidates just disagree on how to get there. And, though the Medicare-for-all plan of Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) has become almost synonymous with “single-payer,” European-style health care, it is not the only way to achieve even that goal — just a disruptive, expensive way.
Enter Sen. Kamala D. Harris (D-Calif.), a backer of the Medicare-for-all concept who nevertheless released her own take on what that should mean shortly before last week’s debate. Rather than force all Americans onto the same government-run plan, she would create a universal version of a system that resembles the actual, existing Medicare program. In essence, Ms. Harris would turn insurance companies into public utilities and allow them to compete with a government-run service.
Seniors on Medicare are able to choose between the government-run option or plans administered by highly regulated private companies. This gives people choices in benefit design and plan administration. Strict regulations mean that profits are not extortionate and that needed care is not denied. Regardless of who runs each plan, the government is ultimately responsible for paying the tab. Ms. Harris’s plan would offer this deal to everyone, regardless of age.
Experience with the current Medicare program, in which about one-third of seniors are enrolled in regulated private plans, as well as in countries that have created similar systems, suggests that people avail themselves of various options when they are given choices. This feature makes these systems no less universal, just less coercive.
Of course, Ms. Harris must answer the same questions that others must. She claims she can provide universal, highly subsidized government-run care without raising taxes on the middle class. To do so, she relies on the math that Mr. Sanders and Ms. Warren have used to make their plan look affordable. But independent analysis indicates that Mr. Sanders and Ms. Warren would raise far too little money to finance their ambitious health-care expansion, which would include dental and vision benefits and no cost-sharing. Unlike Mr. Sanders and Ms. Warren, Ms. Harris might require people to pay premiums, depending on income, which could make her plan fiscally saner. But, on this point, her proposal is not clear.
Ms. Harris appears to be making a massive bet that her long phase-in period — 10 years — would enable the government to finally figure out how to drive down health-care costs, resulting in affordable coverage and benefit expansion when it is fully phased-in. Yet history suggests little cause for optimism on this score.
Ms. Harris’s contribution is welcome. It shows there are ambitious alternatives to so-called Sanderscare that progressives should be able to consider equally, if not more, serious about achieving universal coverage. But Ms. Harris will have to do more explaining before voters can decide whether the numbers behind it are ultimately more plausible than those underpinning the unrealistic Sanders-Warren plan.