Since the launch of her presidential campaign, it has been almost impossible to determine what Sen. Kamala Harris (D–Calif.) believes about health care policy. Over the last seven months, she has said that she supports Bernie Sanders' single-payer plan, and also that she opposes parts of it, that she would eliminate all private insurance, and also that perhaps she wouldn't, and then again that she would, but that actually she misheard the question and in fact wouldn't eliminate private coverage, because she would allow for supplemental insurance for cosmetic procedures, a type of insurance that does not exist.
There have always been two possible reasons for Harris' health policy inconsistencies. The first is that she had trouble explaining the nuances of her plans. Given her talents as a speaker and political communicator, that seems unlikely. The second, and more plausible, is that she simply didn't care about the particulars and was saying what she thought people wanted to hear, whether or not it added up to a coherent or defensible policy.
This morning, Harris released a plan designed to reconcile her health policy contradictions. It provides further evidence for the latter explanation. Although it resolves some surface-level problems with her messaging, as policy it is nearly as muddled and cynical as what came before.
Harris has consistently struggled to describe how she would handle private health insurance. In January, she said she supports the Sanders Medicare for All plan, which would outlaw most private health insurance in four years. Health insurance, she said, was a pain to deal with. "Let's eliminate all of that," she said. "Let's move on." The following day, facing a backlash, she hedged, saying that while she would support eliminating private health she would also back other options. Then, at last month's Democratic primary debate, she raised her hand to signal an answer of yes about eliminating private plans; the following day, she backtracked again, saying she'd misunderstood the question.
Her new plan is thus an attempt to articulate a policy that retroactively makes sense of her previous statements. It would allow private insurance carriers to compete to provide Medicare-approved plans within the structure of Medicare. It thus allows her to support a program that nominally provides for universal Medicare while also allowing some private coverage to exist.
But Harris would still eliminate the majority of private coverage as we know it. Employer-sponsored health care plans, which currently cover more than 150 million Americans, would be allowed only if they were certified as Medicare plans. That means many of today's plans would go away. So would private plans bought through Obamacare's exchanges. If you like your plan, too bad: You can't keep it.
The core political problem for Medicare for All is that a large number of Americans currently have employer-sponsored health plans that they like, and Medicare for All would eliminate many of those plans and force those Americans into government-run insurance. Harris' new plan doesn't really change this. It would still disrupt coverage for millions of people. In other words, it resolves the contradictions in her messaging, but not the deeper policy issues.
Under the Harris plan, the private health coverage that would remain would be so heavily regulated as to be effectively government-run, and the plan would still require a complex transition from the current employer-based system to one where the government is responsible for financing most health care.
Harris attempts to manage transition worries by providing for a 10-year transition, in contrast to the four-year changeover called for by the Sanders plan. But this poses different problems: It would mean that even if Harris won two presidential terms, she would not oversee the final implementation of the plan, exposing it to political upheaval. (Imagine if Obamacare had been timed to go into effect after Obama's second term.) The longer timeline could also result in the shuttering of some of today's insurance carriers before the 10-year window is up, pushing people into the new, government-provided plans before the transition is complete, which makes her promise that "no one will lose access to insurance during a transition" rather dicey.
The 10-year transition also allows her to hide the true cost of the plan. The Congressional Budget Office, which provides cost estimates for legislation, typically estimates the price of only the first 10 years of any given piece of legislation, meaning that the fully implemented program would not be part of the cost estimate.
Harris, tellingly, has not provided any cost estimate of her own, nor has she specified how it would pay providers, a critical issue for determining a price tag. Relying on Medicare rates would reduce the total price tag of the legislation, but would also subject hospitals and doctors to large pay cuts that would almost certainly result in service reductions.
Nor has Harris specified a way to pay for her plan. Instead, she continues to pretend she can finance it without new taxes or fees on the broad middle class, a position that not even Bernie Sanders holds. Indeed, Harris specifically rejects Sanders' proposal for a 4 percent "premium" on households making more than $29,000 annually, reserving that fee for families with incomes over $100,000, and further adjustments for high-cost areas. No country that provides health care benefits on the level that Harris envisions has done so without higher middle-class taxes. Harris is describing a system that does not exist.
With the second series of Democratic presidential debates looming, it was clear that Harris had a health care problem. Even liberals were criticizing her incoherence on the issue. But rather than honestly reckon with the contradictions of her previous statements and the trade-offs inherent in any health policy proposal, Harris has merely attempted to paper over those contradictions with yet another poorly-thought-out, detail-light plan designed to allow her to make promises she cannot possibly keep. Her new plan is pitched as a way of answering tough questions, but it's just another way of dodging them.