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Kamala Harris released her very own healthcare proposal today, an interesting blend of Medicare For All and and private insurance that would phase in more slowly than the four or five years the major proposals for M4A have envisioned. Clearly aimed at preempting the squawks from insurance companies that would be forced out of business by a total transition to single-payer, the plan would allow private insurers to sell Medicare plans, but they would be subject to defined coverage requirements and stricter price controls than the current Medicare Advantage plans that make a lot of money for insurance companies.

Harris's plan would expand Medicare health benefits to include vision, dental, and hearing aids, make a public option to buy into Medicare available immediately, and transition to a full Medicare for All system over 10 years, giving people the choice of private or public Medicare plans. Employers who currently provide health insurance to their employees would transition to either paying for workers' private Medicare plans, or paying higher taxes to support public Medicare coverage. [Small Business Owner Editrix here: I would be delighted to buy actual Medicare for my employees. DELIGHTED.]

It's a hybrid plan that aims for universal coverage without eliminating the insurance industry. We're not crazy about the 10-year implementation framework, but on the whole, it looks like a way of transitioning to single payer that could be palatable to many Americans. Let's wonksplore!


Some chunks of the plan are very similar to the "Medicare Extra" proposal from the Center for American Progress, which we outlined last week. It starts with an expanded suite of services for Medicare, and in its first year, would allow anyone to buy into the system -- there's your public option. It would also enroll all newborns, and all currently uninsured Americans.

Harris argues the 10-year transition period would

give all doctors time to get into the system, and provide a commonsense path for employers, employees, the underinsured, and others on federally-designated programs, such as Medicaid or the Affordable Care Act exchanges, to transition. This will expand the number of insured Americans and create a new viable public system that guarantees universal coverage at a lower cost. Expanding the transition window will also lower the overall cost of the program.

Unlike most of the Medicare For All plans, which would eliminate virtually all private insurance, Harris sees a role for insurers to set up their own plans, as long as such plans "adhere to strict Medicare requirements on costs and benefits." Noting that about a third of current Medicare recipients are enrolled in Medicare Advantage plans sold by private insurers, Harris says,

Medicare will set the rules of the road for these plans, including price and quality, and private insurance companies will play by those rules, not the other way around.This preserves the options that seniors have today and expands options to all Americans, while also telling insurance companies they don't run the show.

Harris says such plans would be "held to stricter consumer protection standards than they are today," and may actually get lower reimbursements than under Medicare Advantage guidelines, "to ensure that they are delivering meaningful value and unable to profit off of gaming consumers or the government." That sounds encouraging, though see also the Supreme Court's ruling in Devil v. Details.

In addition, people would have the option of buying supplemental plans to cover services like insurance for foreign travel, or cosmetic surgery. All in all, Harris's plan looks a good bit like the German system, in which most people have public insurance, but private options are available. There are some differences, but since this is not a compare and contrast essay on Germany we will not go into 'em.

To limit drug costs, Harris would give the secretary of HHS the power to negotiate drug prices. For our money, we'd also like to see European-style price ceilings on all medical services, but we haven't been hired by any campaigns yet. Jeez, people, go read Elizabeth Rosenthal's New York Times articles on that six years ago!

Over time, almost all health insurance would be Medicare of either the public or private sort. Harris would leave the Veterans Affairs and Indian Health Service healthcare systems largely untouched while promising patients would get the best quality care, but otherwise, it would be Medicare for All:

At the end of the ten-year transition, every American will be a part of this new Medicare system. They will get insurance either through the new public Medicare plan or a Medicare plan offered by a private insurer within that system. Seniors will see stronger Medicare benefits than they have now. We will cover millions more people who don't have health insurance today. And we will reduce costs, save our country money, and ensure that no American has to sacrifice getting the care they need just because the cost is a barrier.

To pay for it, Harris is so far talking about options, not yet saying the payments need to come from one particular scheme. She rejects one aspect of Bernie Sanders's M4A plan, which would require households making over $29,000 annually to pay a four percent premium for insurance. Sanders notes that would still be far less than middle-income families pay for insurance, copays, and the like, but Harris would rather see a higher degree of money coming from the wealthy, with no additional taxes for any family making under $100,000 annually, with perhaps higher exemptions in high-cost areas (ahem: Price controls, again!). A Harris spokesperson said the goal would be to make sure annual out-of-pocket costs would be no higher than $200 per person.

Harris also suggests a very tiny tax on all financial transactions:

I would tax Wall Street stock trades at 0.2%, bond trades at 0.1%, and derivative transactions at 0.002%. Think of it like this: that's a $2 fee on a $1,000 trade by investors and big banks. I would also end foreign tax shelters by taxing offshore corporate income at the same rate as domestic corporate income. Together, these proposals would raise well over $2 trillion over ten years, more than enough to make up the difference from raising the middle-class income threshold.

There's a lot to like in Harris's proposal; the one thing we're not crazy about is that ten-year timeline, which strikes us as too incremental and too vulnerable to Republican fuckery down the line. Make it six or seven years and we'd be far less leery. No matter what plan you go with, wingnuts will call it socialism and death panels, and the sooner more people are seeing real benefits, the bigger the constituency there'll be to stop the Party of Asshats from rolling it back.

[NYT / Kamala Harris on Medium / Vox / Harris Campaign / Photoshoop based on image by William Warby, Creative Commons License 2.0]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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