Sen. Kamala Harris announced her health care reform plan Monday: a Medicare for All plan that keeps private health insurance functioning much like Medicare Advantage plans, and transitions to a full government-sponsored plan over 10 years.
"This isn’t about pursuing an ideology," Harris wrote in her Medium post explaining the plan, giving a nod to Republicans screaming "socialism." "This is about delivering for the American people," she wrote. Her plan would allow people to keep private coverage, as long as their plans adhere to the same regulation as the government-offered Medicare plan, making them similar to existing Medicare Advantage plans now. She would extend Medicare coverage to include vision, dental, hearing aids, and mental health services, though the plan doesn't address long-term care—the biggest missing component.
It would be paid for with a 4% tax on people making more than $100,000 annually, a 0.2% tax on all stock trades and a 0.1% tax on bond trades. She would also tax derivative transactions at .002% and tax offshore corporate income at the same rate as domestic corporate income. She estimates that combination would raise $2 trillion over 10 years. That contrasts with Bernie Sanders' Medicare for All plan, which she has also supported, which has the 4% tax levied on taxpayers making more than $29,000 annually—a tax offset, he says, by the fact that no one would have to pay premiums or other out-of-pocket healthcare costs.
After a 10-year transition under Harris' plan, employer-sponsored health insurance would be eliminated. Immediately, all newborns and uninsured people would be automatically enrolled in the government plan. In that first phase, everyone would have the opportunity to buy in. That 10-year transition would "give all doctors time to get into the system, and provide a commonsense path for employers, employees, the underinsured, and others on federally-designated programs, such as Medicaid or the Affordable Care Act exchanges, to transition," she writes.
The private plans she would maintain would have to "adhere to strict Medicare requirements on costs and benefits. This would function similar to how private Medicare plans work today, which cover about a third of Medicare seniors, and operate within the Medicare system." Her government would have to have a major crack-down on those plans for this to really work, as the current Medicare Advantage system she refers to has ripped off Medicare and taxpayers to the tune of about $30 billion over just the past three years by "overbill[ing] the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have." Harris' plan would also allow "supplemental insurance covering services not included in Medicare, such as medical insurance for traveling abroad, or cosmetic surgery." Insurance for elective cosmetic surgery isn't really a thing, though reconstructive and medically necessary plastic surgery is generally covered by existing insurance.
Some of the bigger questions are not answered, such as how much providers would be paid, whether there would be any cost-sharing for patients, and how much the whole thing would cost. Another concern is that a 10-year transition window gives way too much opportunity for Republicans to undermine it, given how politically divisive health care reform has proven to be.
It does, however, speak to where the voting public seems to be right now. People aren't at all uncomfortable with the idea of government-sponsored healthcare: They just aren't ready to let go of the private insurance model they already know. At least, not yet.