Medicare Privatization for All?

Throughout 2019, Harris stumbled repeatedly when prompted to express her views on Medicare for All. In May 2019, in another interview with CNN’s Tapper, Harris said that back in Iowa, when he’d asked her if she wanted to get rid of insurance companies and she said yes, that was actually “not what I meant.”

During a debate in June of that year, when the candidates were asked who would be in favor of eliminating all private health care insurance, Harris raised her hand. Days later, she again backed off the position. The next month, in a Medium post headlined “My Plan for Medicare for All,” Harris finally released the specifics of her health care plan.

“She called it Medicare for All,” said Adam Gaffney, an ICU doctor and the former president of the advocacy group Physicians for a National Health Program. “But it really wasn’t. She did envision covering everyone and that is laudable and that is critical. But the plan maintained a central role for private insurers, and we’ve seen year after year is that private insurers are driving up the cost of care. They are a key problem in our crisis.”

Medicare for All is also known as single-payer health insurance because it would create one federal government entity that would oversee all health care spending. Its advocates believe the best way to provide health insurance to all Americans is by improving and expanding Medicare, a system that has successfully provided health care for millions of people for decades. Advocates also estimate a single-payer system would net $500 billion in savings by mimicking the efficiency of Medicare, which spends just 2 percent of costs on administrative tasks like billing.

Harris’s plan wasn’t a single-payer system. Instead, it aimed to give all Americans the choice of enrolling in Medicare while also likely expanding Medicare Advantage, the controversial for-profit insurance program subsidized by the federal government.

People choose Medicare Advantage because it’s cheap: the upfront premiums average less than $20 a month. What they don’t know is that actually receiving treatment with their Medicare Advantage plan is costly in other ways: critics say that Medicare Advantage insurers profit by denying patients care.

The Journal of Clinical Oncology has found that, in part due to inferior care options, cancer patients in Medicare Advantage have higher mortality rates immediately after surgeries than traditional Medicare enrollees. Researchers studying one large insurer’s data found a fifteen-year increase in denials over a five year period. One in three Medicare Advantage enrollees are denied at least one claim annually. The programs are being investigated by the Department of Justice for fraud.

This privatized version of Medicare has existed in previous versions since at least the ’90s. In 2003, it was renamed Medicare Advantage. Under Donald Trump, it ballooned. In 2018, his administration’s Department of Health and Human Services sent physical letters to millions of Americans saying things like: “See if you can save money with Medicare Advantage.” Under the Joe Biden and Harris administration, its growth continued. Last year, around half of all eligible patients were in Medicare Advantage plans rather than traditional Medicare.

As the American Prospect wrote in 2019, “What’s so insidious about Harris’ approach” is that it “would expand the commercial part of the system, falsely branded as a variant of Medicare, and take us further away from true seamless and universal coverage.” While that’s not good for patients, it’s also not good for the federal budget. As the Lever recently reported, “The federal government is losing as much as $140 billion per year by subsidizing private Medicare Advantage plans.”

As far as the GOP is concerned, Medicare Advantage should get even bigger. Project 2025, a broad package of policy proposals being pushed by the Heritage Foundation as the blueprint for a second Trump administration, wants to set Medicare Advantage as “the default enrollment option” for Medicare.

It’s been fourteen years since Barack Obama’s administration passed the Affordable Care Act and in many ways America’s health care crisis is worse than ever, as health insurance companies have taken advantage of its many loopholes. This year, the prices of health insurance premiums are estimated to reach record highs. By 2026, the number of uninsured Americans is predicted to spike to over thirty million.

By the end of 2019, in the wake of her flailing around Medicare for All, and as her support waned, Harris quit the Democratic primaries.

In the summer of 2020, Joe Biden — who, during his own successful campaign for the Democratic nomination, explicitly said he’d veto any Medicare for All bill as president — named Harris his vice president.

How Harris “Abandoned” Medicare for All

When Harris first began talking about her support for Medicare for All, she often told the story of her own mother who died in 2009 at seventy years old, due to complications from colon cancer. In a 2018 New York Times op-ed, Harris wrote touchingly of cooking “elaborate meals for her, filling the house with the smells of childhood,” and of finding time outside of her then job as San Francisco district attorney to hold her mother’s hand “through the misery of chemotherapy.” She wrote, “I am so grateful my mother had Medicare, and I will fight for it to be guaranteed to all.”

In the fall of 2019, Harris sat down for an interview with Ady Barkan, the Medicare for All advocate who died last year at the age of thirty-nine from complications of ALS. At that point, Harris had already released her Medicare Advantage–boosting health care plan.

At first, the two speak in generalities about the importance of health care over the kind of crescendoing instrumentals that would sound right on a motivational YouTube sports highlights compilation. Barkan asks Harris about her late mother; Harris breaks down in tears. Then, to his credit, Barkan doesn’t let the opportunity slip to push back on the specifics of Harris’s plan.

“You philosophically believe the insurance companies play a useful role and should continue existing?” he asks her, using the augmentative technological intervention he needed to communicate toward the end of his battle with serious degenerative disease.

“I believe that those who abuse the system should be held accountable, but I am not trying to get rid of all private insurance,” she answers. “The problem is they have been writing the rules and they have been taking advantage of consumers.”

Michael Lighty, a longtime Medicare for All advocate, worked as the health care constituency director for Senator Sanders’s 2020 presidential campaign. He was also the longtime single-payer expert for the California Nurses Association/National Nurses Organizing Committee organization, which represents over 150,000 nurses nationwide.

He recalls being initially impressed with Harris’s thoughts on Medicare for All, both during the Des Moines event and on previous occasions, “It was very passionate, very sincere. Her framing was ‘we’re not getting a good ROI on health care,’ which was certainly unique, but she definitely seemed committed to the issue.”

The context for Harris’s eventual retreat, Lighty said, was that support for Medicare for All was making the Sanders campaign a target for huge attack ad spending. “Bernie was getting hit with about a million-and-a-half dollars in Iowa” ahead of the 2020 caucus, Lighty says. Meanwhile Pete Buttgieg, then best known as the former mayor of South Bend, Indiana, “was claiming he had a better plan, some kind of public/private combination.” Sen. Elizabeth Warren (D-MA) “felt compelled to prove how we pay for it in order to distinguish herself, which was not a smart move politically,” Lighty said. “You don’t wanna talk about what it’s gonna cost you, you wanna talk about what it’s gonna save.”

Harris, he explained, was trying to find something to make herself stick out while avoiding the ad spending being directed against Sanders for his support of Medicare for All.

“A majority of voters want the option to keep their plans,” Lighty said. “Primarily that’s because the situation is so bad, they’re desperate to keep what they have.” Political consultants “will tell candidates, ‘You don’t want to be out there telling people you’re taking away their plans.”’

When Harris finally did release her so-called version of Medicare for All, Lighty explained, she “backed off the fundamental principle — a single, publicly administered plan that would eliminate the power of the commercial insurance companies.” For the Sanders campaign, Lighty says, Harris’s plan felt like an opportunity. “So, fine. Not ‘fine’ from a policy perspective, because she’s wrong.” But it distinguished Sanders as the sole champion for a true Medicare for All proposal.

“She had abandoned support for Medicare for All,” Lighty concluded. “We saw it as exactly that.”

In the long fight for universal health care, 2019 was “a very exciting time,” said Gaffney, the ICU doctor. “Single-payer activism had been going on for decades, but for many years had really been on the sidelines” of the political discourse.

Sanders’s 2016 presidential run energized the issue; with the ongoing efforts of progressive activists, and the broader pushback to the Trump administration, Medicare for All suddenly had real momentum. And Harris in Des Moines was a significant moment in the groundswell.

But despite bipartisan support, the movement faltered. “I think many politicians responded to the energy of their progressive constituencies,” Gaffney said. “But it’s one thing to sign on. It’s another thing to stay on.”

“I’ve Never Encountered Kamala”

Alex Lawson is the executive director of the advocacy organization Social Security Works, which aims to expand Social Security and Medicare. He’s an advocate for Medicare for All and has helped draft single-payer legislation introduced in the House of Representatives.

Of the plan Harris proposed in 2019, he said, “I totally reject the idea that the policy is terrible.” He understands why people might be alarmed at the plan’s potential to expand Medicare Advantage. But he said, “Harris’s goal is really clear. It’s to not allow corporate insurers to delay and deny care.”

He doesn’t agree with the people criticizing her approach as an expansion of Medicare Advantage, saying that was not her intention: “I can tell you, I was right there.” As an activist in close communication with both the Sanders and the Harris teams, he saw that “Harris and her staff were looking to guarantee health care for Americans.”

In her 2019 proposal, Harris writes, “Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services. If they want to play by our rules, they can be in the system. If not, they have to get out.”

Lawson points to the Biden-Harris administration’s health care track record, which includes, he says, “the largest expansion of Medicare since the creation of Medicare,” and the creation of price caps on a select handful of drugs for Medicare patients. Harris should be judged on what her administration has done, Lawson argued: “They beat pharma! The unbeatable pharma!”

For Lawson, Harris’s walkback on Medicare for All in 2019 is not as telling as its critics believe it to be. “That episode is not nearly as clarifying as the totality of what she did before, during, and up to now,” he said.

As president, Biden was very cozy with the insurance industry: he welcomed its lobbyists to his very first fundraisers, and he took its cues when crafting emergency relief policies during the pandemic.

What kind of relationship Harris will look to build with insurers is not yet known. According to Open Secrets, Harris now has over $800,000 in donations from the health services sector, which includes insurance giants like UnitedHealth and Blue Cross Blue Shield. (Donations to Biden’s campaign before he dropped out will now be transferred to Harris’s campaign, and so are included in that number.)

The Harris campaign recently told the New York Times that Harris “no longer supported a single-payer health insurance program.” When reached for comment, a Harris campaign official confirmed that to the Lever, adding, “The VP won’t push her 2019 health care plan. She will continue to build on the successes of the Biden-Harris administration — lowering prescription drug costs and making health care more affordable and accessible.” The campaign official declined to elucidate Harris’s vision any further than that.

On July 30 of this year, Harris commemorated the anniversary of the creation of Medicare, signed into law by Lyndon B. Johnson fifty-nine years ago, with a post on Twitter/X: “Trump’s Project 2025 plans to cut Medicare and roll back our progress on Medicaid. As Vice President, I have worked to expand these programs — and we are not going back.” Once, she was clear and bold on the issue; these days, she is a cipher.

RoseAnn DeMoro, the former executive director of National Nurses United, is widely known as one of the most effective union leaders in recent American history. Before retiring in 2018, she helped create real and ongoing momentum for single-payer health care in California and remains an activist for Medicare for All in the state and nationwide. When asked about Harris’s shifting positions on Medicare for All, she first offers a preamble: “I really want her to win, and I hope you say that. She has to win.”

Then she said of her former neighbor in the Golden State, “I’ve been in the political world forever. And I cannot tell you what she advocates. In all my years doing political work in California, in terms of our issues, I’ve never encountered Kamala.”