By now, you've likely seen the viral clip of Sen. Kamala Harris discussing healthcare policy (she has since quasi-reversed herself, in fairly astonishing fashion) during her CNN 'town hall meeting' Monday night. After host Jake Tapper asked whether Americans could keep their existing plans under her "Medicare for All" proposal -- an obvious call-back to a potent line of attack in the Obamacare debate -- Harris effectively said 'no,' concluding that it's time to "move on" and completely "eliminate" the private insurance networks on which most of the country relies:
Calling for Medicare for All, Kamala Harris says of private insurance: ”Let’s eliminate all of that. Let’s move on.” pic.twitter.com/xT2I5IZDfT— Shane Goldmacher (@ShaneGoldmacher) January 29, 2019
Having endorsed Bernie Sanders' legislation, and until she formally shifts from panicked hedging to abandoning her stance, Harris is calling for the destruction of the entire US healthcare system as it currently exists, in favor of a new regime under which non-government options are severely limited:
The Sanders bill she co-sponsored does allow for private insurance as long as it doesnt duplicate any benefits offered by the government plan. That said, gov plan promises a broad array of benefits so supplemental market would seem to be quite limited. https://t.co/ZDR8CaRMz0— Philip Klein (@philipaklein) January 29, 2019
The core functions of healthcare would belong to the government. Consumers would have no choice in the matter. We have repeatedly described the mathematical reality that paying for such a program would require increasing the annual federal budget by at least $3.2 trillion every single year. In 2018, a year in which the government ran a deficit of nearly $800 billion, Uncle Sam spent a little over $4 trillion. If single-payer healthcare had been implemented, the budget would have been roughly $7.3 trillion. To cover the resulting gap, staggering tax increases on every single American would be necessary:
CBO says that raising $32 trillion would require either a:— Brian Riedl (@Brian_Riedl) January 29, 2019
35% payroll tax, or
82% VAT (national sales tax)
Even families no longer paying health premiums won't accept that. And what about 40M Medicaid families who pay no premiums from which to shift to tax?
Dems won't discuss.
As we recently pointed out, once voters are informed about the tax implications, and the delayed care, support for this scheme falls off a cliff. Riedl makes a good point about the tens of millions of Medicaid (and Medicare) recipients who would remain in government-run programs, yet would suddenly have their tax bills go through the roof under "Medicare for All." And then there are the 177 million Americans who get private (and very often far superior) healthcare through their employers, or directly through insurers. Every single one of those people would be dumped off of their plans and funneled into a one-size-fits-all government bureaucracy. Under Obamacare, approximately five million people on the individual market were unable to keep their doctors and plans, despite a bogus political promise. Under single-payer, those affected would entail half of the entire US population. Both political parties have learned, quite painfully, over the last eight years that voters hate the prospect of major disruptions to their healthcare arrangements. "Medicare for All," setting aside its eye-popping price tag, represents the biggest imaginable disruption. Fully embracing it as a litmus-test-satisfying soundbyte is a serious risk, argues Philip Klein:
An effort to "move on" from private insurance would be tremendously disruptive. In 2017, the most recent year for which data are available, there were 156.2 million people who obtained private insurance through their employers, and 20.5 million who had it directly through insurance companies, according to the Kaiser Family Foundation...Furthermore, Americans with private coverage by and large like it. According to Gallup data, 70 percent of those with private insurance rate their coverage as "excellent" or "good," and 85 percent say the same about the actual healthcare they receive. Harris would be throwing more than half the country off of plans they're currently comfortable with in exchange for a promise of a great new hassle-free government plan that doesn't exist yet...This doesn't even take into account the other tradeoffs involved with converting to the system she's calling for. For instance, the staggering taxes that would have to be levied not just on the uber rich but also on the middle class; the massive layoffs that would result from putting a major industry out of business; the access problems that result when you're giving everybody "free" healthcare while putting downward pressure on payment rates to doctors, hospitals, and other medical providers.
Based on last night's performance, I was seriously doubting Harris is prepared to defend her plan against these fundamental criticisms -- including the jobs-killing element that I hadn't even touched upon yet. Her hasty retreat confirms my suspicions. The question is whether any of the candidates who will adopt this platform plank can offer detailed, specific, honest, and appealing explanations of how it would work, how it would be paid for, and how it would affect people. Supporters of single-payer often resort to slogans (it works everywhere else, right?) and specious arguments to deflect away from difficult realities. But slogans cannot wash away those realities. On that score, this underscores an argument I made yesterday about one of the weakest, math-illiterate counter-points to the 'pay for' challenge:
Let's Compare:— Brian Riedl (@Brian_Riedl) January 29, 2019
A) 2017 Tax Cuts - $2T over 10 yrs then require renewal vote to reach $9T over 30 yrs
B) Medicare For All - $32T over 10 yrs, growing to $170T over 30 yrs
"A" should have been paid for. But using that as an excuse to not pay for "B" is completely insane.
To put it more bluntly, when politicians talk about reversing the 2017 tax law (thus raising taxes on the middle class) and wringing more money out of "the rich" to supposedly "pay for" Medicare for All, they are either recklessly ignorant, or they are lying to you. One last point: Kamala Harris' key selling point in her half-abandoned answer is that people hate the red tape of dealing with private insurers. The idea of snipping that red tape through a much simpler system has some appeal, but have Americans ever encountered dealing with...the government? The idea of taking the VA model -- riddled with corruption, abuse, and long waits -- and forcing every American into it is in no way a recipe for eliminating bureaucratic headaches. In summary:
Yes, uproot 150 million+ Americans from their existing healthcare arrangements, eliminate private plans, and hand the whole thing over to the famously-efficient, never-corrupt & super-accountable federal bureaucracy! How to pay for it? Lol, ‘let’s move on’ from that question too! https://t.co/khzmrlrnRH— Guy Benson (@guypbenson) January 29, 2019
By the way, Medicare as it exists -- let alone "for all" -- is going insolvent. I'll leave you with this thought about Harris' flip-flop (more on this later):
And thus opens a clear policy attack from her left (and right) on a huge issue — and a preparedness/judgment attack in general https://t.co/zsNIVMUeNd— Guy Benson (@guypbenson) January 30, 2019