Walk Before You Run: Why Kamala Harris's Medicare is Fool's Gold

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Besides many other obvious reasons, Democrats won in the 2018 midterm elections because healthcare reform was number one on the electorate’s agenda for change. With that directive in hand, the words du jour of politicians seeking our vote for 2020 is that healthcare is a right that must be accessible and affordable. I scribed such thoughts over a decade ago, before Ted Kennedy spoke of it at the 2008 Democratic National Convention and before Obama spoke of it during a 2008 presidential debate in Nashville in October of 2008. I also wrote about it in various publications, like Clinical Endocrinology News (July 2008) and as referenced in a piece for this site months ago. Healthcare as an accessible and affordable right is not new in our lexicon, as they date back to decades past when FDR in 1943 crafted his proposed “Second Bill of Rights.” It was included as one of four essential liberties, “freedom of want,” in turn meaning the right to adequate medical care and the opportunity to enjoy good health. This right to healthcare was subsequently enshrined in the Universal Declaration of Human Rights, a 1948 United Nations document that declared

“…everyone has the right to a standard of living adequate for the health and well-being of oneself and one’s family, including food, clothing, housing, and medical care.”

As we know, 2010’s Affordable Care Act (ACA) was the most successful attempt at bringing life to these words, pointing to healthcare as a freedom to which we should all be entitled without hardship in acquiring, affording, and maintaining it. The ACA has had its share of slings and errors, the most recent being a federal court judge in Texas this past December declaring the entire act unconstitutional since its core – the individual mandate – was stricken by Trump’s tax law in late 2017. Similarly, earlier this month, a federal judge in Baltimore dismissed Maryland’s attempt to ensure the preservation of the law as constitutional because it was in danger of being dismantled by the Trump administration. The Baltimore judge wrote, “But the state’s allegations do not create a plausible inference of a substantial or certainly impending risk that the Trump administration will cease enforcement of part or all of the ACA.”

While the Texas case is on appeal to the 5th Circuit Court of Appeals in New Orleans, healthcare as a right has been around for a very long, time. It is the process to implement it that has been our nation’s bugaboo.

So now comes Senator Kamala Harris, declaring her run for president with a platform inclusive of proposing a Medicare for All system, thus eliminating the entire private health insurance marketplace. Before her, it was Senator Bernie Sanders’ single-payer, universal healthcare coverage legislative initiative, and Senators Warren, Gillibrand, and Booker have become co-sponsors of it.

Michael Bloomberg, former NYC mayor and potential presidential aspirant, tells us that eliminating private insurers would bankrupt the country. Even potential independent candidate Howard Schultz has given two thumbs down on Harris’ idea, calling it “not American.” And we know Trump’s petulant behavior includes shutting down the ACA. These expressions show in microcosm the complexity in solving the nation’s healthcare dilemma.

At this stage, Harris’ idea is more to attract the attention of voters in her prepubescent presidential run than anything of substance worth seriously considering and enacting if she were elected president. It is her form of grandstanding on a national issue of critical importance since, in a recent Kaiser Health News podcast showcasing healthcare experts, the prediction is there will be endless talking and not much, if any, legislating. It is credibly hypothesized that efforts to change the ACA or assist in stabilizing insurance markets also will likely take a back-seat to the Democratic horserace that expands daily by those from that party wanting to be our next president.

This is said knowing that at the beginning of February, three House subcommittees held hearings to investigate Trump's efforts to dismantle the ACA over the last two years, in so doing, looking to strengthen the law; to restore funds for ACA counselors that guide folks in enrolling in health plans; and to prevent the administration from granting waivers to state insurance programs looking to skirt the mandates contained in the ACA.

We need to crawl before we walk, and walk before we run. With her expansive health care for all idea, Harris’ suggestion is more like a sprint to the finish line, leaving in her wake how to pay for it. Recall Vermont’s attempts to implement a single-payer system but abandoned it in 2014 because they could not figure out how to pay for it. To put this another way, the candy in the candy store looks awfully inviting standing on the sidewalk, but a mouthful of it can cause a whole lot of cavities.

Equally dangerous is the public’s denial of government assistance in their lives. In referencing Cornell political scientist Suzanne Mettler’s survey of those receiving government benefits, columnist Richard North Patterson ably summarizes, “The classic example is the angry constituent who [tells] his congressman, ‘Keep your government hands off my Medicare.’”

Obama gave us the ACA to which a majority of Americans have grown accustomed and have approved. Assuming its constitutionality is restored by the federal appeals court or even the Supreme, it needs to be strengthened and improved, not tossed aside by those advocating for a completely new way to ensure health as a right for all.

As you might recall, Obama wanted a public option as part of his “Obamacare,” i.e. healthcare insurance delivered through a government-run program that would compete with the private health insurance market. When I was brought to Congress to advise on the ACA as it was being developed, I was in favor of it so long as it did not repeat the mistakes of the then-existing private market interfering with our doctors deciding what is best for us-and ensuring lower out of pocket costs. Obama could not get it over the finish line, with the individual mandate substituted in its place due to intense lobbying by the most affected industries. Now that the individual mandate is history, it makes sense to revisit a public option for there is no reason to fear it.

To be sure, revisiting the public option and speculation about a Medicare for All system invites considerable debate due to the complexity, nuances, and idiosyncrasies of the American healthcare system. No one should dispute this.

Adding a public option to ACA – again assuming it remains the law of the land – is an adequate replacement for what the individual mandate was intended to do: lower costs because everyone had to purchase insurance to broaden the insurance risk pool or else face a penalty/tax. A publicly-run entity would also provide needed competition for those companies in the private sector wishing our healthcare insurance dollar.

Another walking-before-running option is to maintain ACA, with or without a public option while making necessary tweaks to it, but also open up Medicare to those aged 50 years and older. This approach has been advocated by the likes of Sen. Amy Klobuchar, who recently announced a 2020 presidential bid. Even Harris’ camp seems to have walked back her Medicare for All approach by hinting at opening up Medicare to those younger than 65. A Kaiser poll found that 77% of adults polled would support those 55-64 to purchase health insurance through Medicare.

Sen. Debbie Stabenow (D-Mich.) is a sponsor of legislation for a buy-in to the Medicare program for those over 50-years-old; a similar buy-in bill pends in the House with its chief sponsor being Brian Higgins (D-NY). While lobbyists want to kill "Medicare for All", they see ACA as working reasonably well and should be improved, not repealed by Republicans or replaced by Democrats with a program like single payer, universal or Medicare for all-type programs. But whatever the proposal at the national level, options, their alternatives, and their definitions need to be clearly understood by all stakeholders and certainly voters.

The latest exposition on expanding Medicare is legislation introduced less than two weeks ago in the Senate by Senators Stabenow (D-Mich.), Baldwin (D-Wisc.), and Brown (D-Ohio), titled "Medicare at 50 Act." According to Forbes, this act “would allow people between 50 and 64 the option of buying into Medicare." Similar (single-payer) legislation is planned for introduction in the House by Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) that, as of February 14, had 93 co-sponsors with an expectation that over 100 will lend their support to the measure.

Other talk before 2020 will include possible reforms at the state level. This includes a public option or some form of it as advocated by Illinois’ new Democratic governor J.B. Pritzker while on his campaign trail, passing an individual mandate, expanding Medicaid, and providing subsidies for those less able to afford health care premiums.

So, don’t be beguiled by Senator Harris’ disquisition of a Medicare for All plan as a way to reach the ultimate goal of guaranteeing health care as a right for all Americans. Remember, all that glistens can be fool’s gold; her proposal comes with significant downsides, not the least of which is its tremendous cost.

Walk before you run.