This is part 2 of a series of posts I’m doing to compare the policies of the frontrunners for the Democratic presidential nomination. You can read Part 1 here, which discussed my general rationale and methods for these posts and looked at issues related to democracy and political reform. Since that post took care of all the introductory stuff, let’s jump right in.
The Affordable Care Act was a major achievement that brought health insurance to millions, and improved it for those who already had it, but anyone who has had any experience with health care in this country should know that it is a deeply broken system.
My first son was born at the end of 2016 and had to spend 20 days in NICU. He was about as healthy as it is possible to be while requiring a NICU stay, and yet when all was said and done the bill for his care was over $100,000. Thankfully, I was able to choose decent insurance to help cover most of those costs, but we had to argue with the insurance company over the course of months to get them to cover everything they were supposed to. It was a whole ordeal just to get an itemized list of costs from the hospital for the services they were providing. I am haunted by the fact that many people don’t have insurance in the first place, or don’t have the time or ability to argue over the details of their coverage. Having a child in the hospital is stressful enough without having to worry that it is going to bankrupt you.
A free market approach just does not work for services like health care. It’s not a “free market” when I have no choice but to pay for a service, and even if I did there’s no way to see what it is going to cost me. It’s not like we could shop around for a different NICU to take our newborn son to for emergency treatment. And it is deeply immoral for people with more money to be able to get better care simply because they can pay for it.
Health care is a really complicated topic, so it was a real challenge to distill some of the candidate positions down and to compare them on an even footing, but I tried!
There’s a lot more detail here than there was for the previous topic, which is great. Of course since Biden is running as the Democratic successor to Obama, his plan calls for building on the ACA rather than switching to something completely different. However, one of the first things in his plan is the availability of a public option similar to Medicare that would be able to negotiate lower prices with providers. To me that sounds like a great step in the right direction. He also talks about a tax credit to help middle class families pay for coverage. I generally don’t love tax credits as a way of providing services, but ok I guess that’s good. His plan also would fix “surprise billing” from specialists who are out of network but work at an in-network hospital, and would use antitrust laws to help fix the lack of competition in some parts of the health care system.
There is also an extensive section on lowering prescription drug prices, with ideas including: repealing a law that prevents Medicare from negotiating with drug companies, independent review board to set prices for new drugs with no competition, allowing people to buy prescription drugs from other countries where prices are lower, getting rid of the tax break for pharmaceutical company advertising, and improving availability of generic drugs.
A final section is focused on access to health care. It places access to contraception and abortions front and center, along with repealing the Hyde amendment, and restoring funding to Planned Parenthood. This section also talks about rescinding the “global gag rule” preventing the US from aiding international organizations that dare to mention abortion. There is also mention of adopting a policy pioneered in California to reduce maternal mortality rates. Other topics include ensuring access regardless of gender, gender identity, or sexual orientation; investing in community health centers; and expanding mental health care.
At the very end of Biden’s health care page, he promises more details in the future on health care in rural communities, and in relation to gun violence and opioids. There is also a little bit at the end about how he proposes to pay for all of this by eliminating capital gains tax loopholes for the super rich.
All in all, I found Biden’s health care page to be very good. Yeah, maybe it’s a lot of smaller and less sexy changes than just making sweeping statements about “Medicare for All” but it also strikes me as well thought-out and realistic.
Compared to Biden’s extremely detailed Health Care section, Sanders’ page is kinda laughable. Sanders famously is in favor of a “Medicare for all” single-payer option, and that’s pretty much all his page says. There are a few bullet points about lowering drug prices with ideas that are mostly similar to what Biden’s plan listed: allow Medicare to negotiate drug prices, allow people to buy drugs from other countries, and pegging drug prices to the median of five other major countries. I guess the lack of detail on Sanders’ page could be chalked up to the fact that a lot of what Biden is trying to fix with specific tweaks should get sorted out by the drastic shift to a single payer plan for everyone, but still, I expected better than this. Medicare for all is great, but you need a plan on how to get there from here.
I can’t find anything resembling a Health Care section on Warren’s website. She mentions Medicare for All in the context of how her proposed tax on the ultra rich would pay for a variety of things, but that’s about it. There’s speculation that this lack of detail is strategic, allowing her to lump herself in with Sanders on this issue, but since Sanders also has essentially no details, that doesn’t really help. Gotta say, I’m disappointed in both of them. I hope they flesh out their plans soon.
Harris has a detailed health care section! As before, her site is quite a bit more verbose than others, but in this case there are plenty of good specifics. She is in favor of Medicare for All, and after some introductory text, she gets right to the heart of the matter: how do we get to medicare for all from our current system? This is my big question about Medicare for All, so I’m excited to see a candidate who actually addresses this.
Her plan would start with allowing Americans to buy into Medicare immediately, and specifically says this would be similar to Sanders’ bill. Then there would be 10-year phase in period where newborns and the uninsured are automatically enrolled in Medicare, doctors can get added to the system, and others on Medicaid and ACA plans can transition. And the third part of the plan is to allow private insurance to offer Medicare plans as long as they follow strict guidelines. People will still have the option to buy supplemental insurance for stuff Medicare doesn’t cover.
Harris’ plan also mentions that the Medicare for All system would have to meet certain benchmarks along the way to ensure it is working the way it is supposed to. “Data matters and should inform our transition.” Music to my data-loving ears.
She then talks about costs and says that the 10-year phase in period will make the transition less expensive than Sanders’ plan. She also contrasts with Sanders’s plan to levy a 4% tax on households making more than $29,000, saying this hits the middle class too hard. (I find it ironic that I’m getting more details about Sanders’ plan from his opponent than from his website.) Instead, Harris would raise that threshold to $100,000 with adjustments to that threshold for high cost of living areas. To make up the difference, she would add a small tax on stock trades (2%), bond trades (1%), and derivatives (0.002%), and tax offshore corporate income.
Harris also has separate pages on drug prices and women’s health. For drug prices she proposes having HHS set the fair prices for drugs based on prices in other first-world countries. She also mentions ending the advertising tax loophole and directing the proceeds toward the NIH. Her plan also addresses the likely scenario where congress does not take action on drug prices in the first 100 days. In that case, Harris says she would take executive action to investigate price gouging and and if a company is found to be overcharging, work to import lower cost drugs from other countries or refer the company to DOJ investigation. If that doesn’t do the trick, then for drugs developed through publicly funded R&D, there is apparently a law that allows the government to license production of that drug to a lower cost company.
Her plan for women’s health would take a page from the Voting Rights Act, and require states with a history of discriminatory practices regarding abortion access to pre-clear new laws with the DOJ. Similarly, it would prevent any abortion law from taking effect until DOJ determines it complies with Roe v. Wade. The plan also includes provisions for future dates after a Harris administration when DOJ might be hostile to abortion rights again, codifying that the DOJ must do the reviews mentioned above and that the people have the right to challenge the DOJ’s approval in court. She also mentions protecting Planned Parenthood, repealing the Hyde amendment, appointing judges who respect Roe v Wade, and rolling back the Trump administration’s rules that limit access to contraceptives and abortions.
All in all, I’m very impressed with Harris’ health care plans. They’re ambitious but well thought out and realistic.
Buttigieg has a pretty slim section on health care. He proposes a “Medicare for All Who Want It” plan where people can buy into a public option. The idea being that this would force private insurers to lower costs and do better or else would lead to a smooth transition to Medicare for All. Beyond that he just has a bulleted list: improved health equity, invest in maternal and infant health, lower drug prices, more affordable long term care, invest in mental health, and combat the opioid and meth epidemics. I guess I’ll count the items on this list for the summary table at the end of this post, but barely. Pretty disappointing.
O’Rourke has a brief health care section with some more detail on certain issues. His plan is basically in the “Medicare for all who want it” camp. Anyone who doesn’t have health care would be enrolled in Medicare, and everyone would have the option to enroll, but could opt to stick with their employer’s private insurance plan. No discrimination for pre-existing conditions. His plan would also cover long-term care.
On drug prices again a lot of familiar ideas. Importing drugs from Europe and Canada, allow Medicare to negotiate drug prices, and have the government step in and license production to other manufacturers if drug companies refuse to set reasonable prices.
On reproductive health care he has a more extensive page, divided up into executive, judicial, and legislative sections. In the executive section, he talks about appointing an attorney general who would honor Roe v. Wade, as well as reversing the “gag rule” and increasing Title X funding with no restrictions on use for abortions, effectively overturning the Hyde amendment. He also mentions removing FDA labeling regulations related to medication-induced abortions. The judicial section is short and sweet: appoint judges who respect Roe v Wade and women’s right to choose. In the legislative section, he points to existing legislation that would address many of the issues: the Women’s Health Protection Act and the Equal Access to Abortion Coverage in Health Insurance act. Specifically, he supports legislation that would affirm a woman’s right to choose, ban regulations that are meant to close clinics, prevent mandates for unnecessary ultrasounds and waiting periods, repeal the Hyde amendment, and prohibit abortion restrictions on private insurance. And then he points back to a universal health care system that includes contraception and abortion coverage.
He also has a brief section on racial disparities in maternal and infant mortality. O’Rourke would address this by using Title X and the National Health Service Corps to reduce “maternal health deserts”, ensure access to all maternal health screenings as well as midwives/doulas, and ensuring mental health services for new mothers and expanding home visiting programs.
Overall, on health care Biden and Harris lead the pack in terms of detailed plans, with Harris being more ambitious. I really liked the fact that she spent time explaining not just that our current system is broken and needs to be replaced with something better, but talked about how to make that transition happen. O’Rourke also had a decent amount of detail, especially on reproductive health care. Sanders, Warren, and Buttigieg were pretty disappointing on such an important topic. If I was a single-issue voter on health care, Harris would get my vote.
|Medicare for all||X||X||(phase-|
for all who want it
|Review board to set |
prices for new drugs
|Import drugs / peg prices |
to other countries
|Re-license drug production|
if prices are too high
|Get rid of drug ad tax loophole||X||X|
|Repeal Hyde amendment||X||X||X|
|Protect Planned Parenthood/|
allow federal funding
|Rescind “gag rule”||X||X||X|
|Address maternal mortality||X||X||X||X|
|Ensure access for |
|Talks about how to |
pay for plans
|DOJ oversight on |
|Long term care |
|Invest in mental health||X||X||X|
|Address opioid epidemic||(coming |