By Megan McArdle
The Washingotn Post
Just in time for her second Democratic presidential debate appearance, on Wednesday night, California Sen. Kamala Harris has unveiled a Medicare-for-all plan.
The timing of Harris’s release is excellent news for health care wonks; now CNN’s Dana Bash, Don Lemon and Jake Tapper will have had an opportunity to ask her to fill in the plan’s somewhat scanty details. Here are some questions about Harris’ Medicare-for-all plan the debate moderators might want to consider:
Sen. Harris, like Bernie Sanders, you envision your Medicare-for-all plan covering many services that Medicare currently doesn’t, such as dental, vision and hearing aids. Will it eliminate co-pays and out-of-pocket expenses, as the Sanders plan does? Exactly how much do you estimate this plan will cost?
Your plan will make private insurance illegal for covered services. Will clinics and physicians be able to provide covered services for cash, or will there be no way to obtain those treatments outside the public system?
Unlike Sen. Sanders, who foresees a four-year transition, your plan would take 10 years to fully implement. That’s more than two full presidential terms. Republicans are likely to hold one or more branches of government during at least part of its implementation. Do you expect Republicans to behave differently toward your plan than they did toward Obamacare?
Your plan will cover “comprehensive reproductive health care services.” Presumably that means childbirth, contraception and abortion, but will it also cover fertility treatment? Gender reassignment surgery?
After your plan is established, a Republican Congress might well abolish coverage for controversial items such as abortion, embryo-destroying in-vitro fertilization or gender reassignment surgery. Or a Republican administration could drop the reimbursement rates for those things so low that no doctors or hospitals could afford to provide them. If that happens, how would Americans get access to those services under your system?
You say pharmaceutical companies won’t be able to charge Americans more than they charge “comparable countries.” It’s likely that high drug prices in the United States encourage pharmaceutical firms to pour more funds into very expensive drug development projects, in the hopes of reaping those outsize rewards. Many experts worry that U.S. price controls would reduce the number of lifesaving new drugs produced. Will your plan monitor drug markets to verify that lower drug prices haven’t meant firms and investors pulling back from drug development?
If R&D does decline, what alternative mechanism would you use to ensure that we don’t inadvertently shut down a development pipeline that’s still delivering revolutionary treatments for serious conditions such as cancer, hepatitis C and multiple sclerosis?
Your plan offers an immediate buy-in to existing Medicare for non-seniors. Presumably, when people do buy in, you plan to pay their providers at current Medicare rates, which are well below those offered by private insurance. If a lot of people buy in to Medicare, hospital revenue will be sharply hit, and with hospital operating margins averaging only 2.56 percent, they’ll need to streamline operations to stay solvent. What services, facilities or staff positions should hospitals be cutting over the next few years to balance their budgets? How will you deal with hospitals that end up insolvent anyway?
As you probably know, the trust fund for Medicare’s hospital insurance program will run out in 2026, and under current law, benefits will have to be cut to match revenue. If we’re going to add a lot more people to Medicare, it will be even more critical to stabilize the program. How will you do that? Can it be managed without even deeper cuts to hospital payments?
If you expand access without increasing the number of doctors and other providers, then people who currently have insurance are likely to experience longer wait times or difficulty finding a doctor who will take new patients. Will your plan do anything to increase the number of doctors and other providers?
Your Medicare-for-all plan uses the basic framework offered by Sen. Sanders, both in the comprehensiveness of its benefits and in many of the taxes that are proposed to offset its costs. Yet many experts think that his “revenue raisers” would barely cover even half of the new spending. How would you close that gap?
A recent Kaiser Family Foundation poll found that while majorities support the generic idea of Medicare-for-all, support drops dramatically if Medicare-for-all means threatening the current Medicare program, paying higher taxes, losing private insurance, or enduring delays for tests or treatments. How will you reassure those Americans who fear that your plan would involve all those things?
Follow Megan McArdle on Twitter @asymmetricinfo.
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