Sen. Kamala Harris' (D–Calif.) health care flip-flops are, first and foremost, a referendum on Kamala Harris, the candidate, and the fundamental emptiness of her presidential campaign.
Harris doesn't really care about health policy as policy; instead she appears to view the issue through an exclusively political lens, wanting to be seen as a supporter of Medicare for All and its most popular promises without reckoning with the trade-offs that a real single-payer health care system of the sort proposed by Sen. Bernie Sanders (I–Vt.). Sanders may be in it for the revolution, but Harris is in it for the optics.
This dynamic helps explain the campaign trail sniping between the two candidates yesterday after Harris reportedly told a group of supporters at a fundraiser that she was "uncomfortable" with Sanders' Medicare for All plan, a single-payer system that would eliminate virtually all private health coverage in four years.
I don't go to the Hamptons to raise money from billionaires. If I ever visited there, I would tell them the same thing I have said for the last 30 years: We must pass a Medicare for All system to guarantee affordable health care for all, not just for those who can afford it.
— Bernie Sanders (@BernieSanders) August 19, 2019
Yes, that's the same Medicare for All plan that Harris co-sponsored all the way back in 2017, the same Medicare for All plan that she came out swinging for when she launched her presidential bid in January, the same Medicare for All plan she was listed as backing as recently as April of this year. Harris has backtracked on health care multiple times over the course of the year, but it's hard to believe she was genuinely uncomfortable with a plan she so prominently backed.
What's more likely is that Harris was uncomfortable not with the plan itself, but with the unpleasant political position it put her in—having to defend not only the substantial cost of the plan but its swift elimination of private coverage and the disruption that would cause. Harris wanted to be seen supporting the popular underlying idea of Medicare for All and a government-granted guarantee of comprehensive coverage, but not face difficult questions about what it would cost or how it would work.
Which is why her own plan, released earlier this summer, is best understood not as a health care plan, but as a campaign messaging document that allows her to say she supports both Medicare for All and some allowance for private health insurance. Notably, her plan contained no cost estimates and pushed the transition back 10 years—conveniently ensuring not only that it wouldn't happen during a Harris administration, but that conventional congressional cost estimates, which cover the legislation's first decade, wouldn't show the full cost of implementation. It's a plan that hides its least popular elements beyond the scope of a conventional legislative price tag, and past the political accountability of a two-term president.
Yet her plan, which allows private insurance only if is essentially designed by the government, would still lead to the elimination of employer-sponsored coverage as we know it, disrupting coverage for tens of millions of people in the process—something that Harris herself has awkwardly admitted.
Harris isn't a health care wonk. She hasn't devoted herself to the issue or its nuances, and whenever she's pressed even mildly about it, she seems to trip up, as if she hadn't anticipated basic questions about how her plans would work (or not work) in practice. Instead, she's an ambitious politician attempting to craft a policy that will best position her in the Democratic primary, somewhere between the single-payer-or-bust enthusiasms of Sanders and Sen. Elizabeth Warren (D–Mass.) and the Obamacare redux of the frontrunner, former Vice President Joe Biden. And her ambitions have repeatedly led her into a cynical and shallow embrace of ideas that she can't fully defend, that fall apart upon even the mildest inspection.
Yet because Harris' position on the issue is the result of such undisguised politicking, of the desire to pinpoint some rhetorical middle ground that offers maximum electoral appeal, whether or not it makes complete policy sense, her personal twists and turns also offer some insight into the Democratic Party's larger conundrum.
Like Harris, the Democratic base rushed to embrace Sanders-style Medicare for All, and like Harris, its most popular proponents have not been able to answer key questions about it, especially when it comes to financing the new government spending such a system would entail. And while the party's left flank has stood by the plan and its essential radicalism, it's not clear that much of the rest of the party even agrees on what it means. That's why both "Medicare for All" and copycat labels like Medicare for All Who Want It have regularly been deployed by those who favor something less than full-fledged single-payer, but still want to seem like they support the same basic goals.
So while it's true that Harris' chief rivals for the Democratic nomination—Biden, Warren, and Sanders—have clearer individual visions when it comes to health policy, it remains the case that the party as a whole is both divided and muddled in its thinking. Any Democratic candidate who won the nomination would face the same challenge of reconciling those conflicting impulses, and then defending and explaining them to the voting public at large. And as Harris has shown, that isn't easy, because it's not possible to wish away the costs and trade-offs of health policy, to craft a plan that is all popular provisions with no downsides.
So it's not just Harris who has a problem with Medicare for All; it's the entire Democratic party.