Debate Fact Corrections/Elucidations
In the heat of the Presidential candidates’ debate, crucial misinformation is inadvertently conveyed; some because the candidates don’t fully understand all the implications and intricacies of their own plans or those of their rivals, and some because they seek to elevate their own plans while dismissing their rivals.
1. The Biden plan does leave about ten million American residents uninsured; these are primarily undocumented workers and their family members who do not yet have legal status. The Biden plan does cover them for emergency care and deliveries if they are poor. Virtually all the Democratic immigration reform measures provide them a path to legal residency and eventually citizenship if they complete all the hurdles. Once they have legal status, they become eligible for full scope Medi-Cal in a state like California; in other states, there is a five-year waiting period. Under the Exchanges (Covered California) they become eligible for premium assistance once they have legal status; there is no waiting period. Under the Biden plan, the undocumented can use the Exchanges to purchase coverage, but without being eligible for premium assistance; there is, however, no reason for them to do so since they can buy the same coverage from the same plans on the individual market at the same price; this is California law. Public health coverage for the undocumented is a hot button issue. California, Texas and Florida are home to many undocumented, uninsured; Maine, Minnesota, Vermont and Montana maybe not so much; California has been a leader in offering Medi-Cal to low income undocumented children and young adults.
2. The Harris plan allows any American to enroll in either Medicare for All or private insurance offering the same benefits, no deductibles and no copays. This is the same way that Medicare Advantage now works for seniors and the disabled. She is being true to the current Medicare model. Senators Sanders and Warren are not being true to the current Medicare model because they believe that private insurance plans are inherently bad policy. Insurance plans whether run by the government or by private insurance have to say “no” to providers and to patients; that’s part of their job description. No, that’s not an effective or a covered service; no that’s still experimental; no that bill is too high. What needs to be avoided is catching the patient in the middle after the care has been delivered with a high medical bill and the provider threatening to sue. On the other hand if a patient wants to try an unproven, experimental procedure, patients need to be able to do so with a full and complete understanding it’s not covered and not going to be paid for. Personally, I think that the Harris plan is both better politics and better policy than the Warren/Sanders plan, but that is because I favor consumer choice, plan competition, integrated delivery networks and provider cooperation and innovation as a way to improve the delivery of medical care and services. On the other hand, some of the insurance plans are just as bad as Senator Warren describes while others (I’m thinking Kaiser here, but there are others) are a far superior model to Medicare for All. The issue of whether to retain or eliminate entirely private insurance is a hot button issue. It appears that Senator Booker and Senator Harris now both favor retaining a role for some private insurance plans as an alternative to straight Medicare within the Medicare for All framework. Representative O’Rourke and Mayor Buttigeg are also espousing similar approaches.
3. The Sanders/Warren plan does rely on a 4% individual income tax surcharge to help pay for it. Their justifications are that they are offering better benefits (dental, vision, hearing aids) with no copays, no deductibles and no premium contributions with unrestricted choice of providers, and that the middle class in the aggregate is better off under their plan. This is true; however there are a number of individuals with private insurance with no low copays, no deductibles and low or no premium contributions. These plans are primarily for public employees and some unionized workers and some top executives and top management. In some of these cases, the unions have negotiated better health coverage and given up wage gains instead; this particular trade-off is abetted and enhanced by federal tax law under which wages are taxed as income to employees while employment-based health benefits are not. Some of these plans are operated by unions, and their plan leaders and administrators would lose their jobs under Sanders/Biden just as would other private insurers. Some of these plans are interwoven with union and public employee disability and retirement benefits as well, and that would need to be disentangled. As a result, some union leaders and some unionized workers believe that the Sanders/Biden plan should either preserve their favored health benefits or require their employers to correspondingly increase their wages. Representative Delany referred to some of these complexities when he argued “if it ain’t broke, don’t fix it” invoking his IBEW (International Brotherhood of Electrical Workers) father and the need to retain a role for employment-based coverage while offering a Medicare buy-in for all. The debates gave insufficient time to explore the many interesting ideas being developed by very thoughtful and capable candidates and were far too focused on 10 second soundbites.
Prepared by: Lucien Wulsin
Dated: 8/1/19