What’s Missing From the Biden-Bernie Task Force Plan? Medicare for All.

The recommendations are an improvement on Biden’s previous healthcare plans, but a public option won’t cut it. We need free, universal coverage.

Natalie Shure July 9, 2020

Medicare for All was conspicuously absent from the task force recommendations. (Photo by JoeBiden.com via Getty Images)

On Wednes­day, the uni­ty task forces” set up by pre­sump­tive Demo­c­ra­t­ic pres­i­den­tial nom­i­nee Joe Biden rolled out a set of pol­i­cy rec­om­men­da­tions for the can­di­date, and, by exten­sion, for the par­ty writ large. Launched in May, the group behind the pro­posed plat­form was com­prised of a core of estab­lish­ment-aligned politi­cos as well as allies of Bernie Sanders, the primary’s run­ner-up whose cam­paign advanced an agen­da square­ly to the left of Biden.

However beefy a public option turns out to be, there are things it can never do.

While the task forces pro­vid­ed rec­om­men­da­tions on issues rang­ing from cli­mate change to crim­i­nal jus­tice, the health­care group attract­ed much atten­tion as observers won­dered how the group would square the wide gap between Sanders’ unwa­ver­ing calls for a sin­gle-pay­er Medicare for All sys­tem, and Biden’s com­mit­ment to main­tain­ing the pri­vate insur­ance sys­tem enshrined by the Afford­able Care Act (ACA).

Unsur­pris­ing­ly, the task force did not endorse Medicare for All, which would essen­tial­ly liq­ui­date the exist­ing ver­sion of pri­vate health insur­ance and replace it with a sin­gle pub­lic sys­tem that cov­ers every­one and pro­vides all nec­es­sary and effec­tive care free from the point of use. But the pres­ence of for­mer Michi­gan guber­na­to­r­i­al can­di­date and sin­gle-pay­er advo­cate Abdul El-Sayed as well as Rep. Prami­la Jaya­pal (D‑Wash.) — who each endorsed Sanders, and the lat­ter of whom is the lead spon­sor of the Medicare for All bill in the House — was evi­dent in more left-lean­ing mea­sures than Biden has pre­vi­ous­ly embraced. If the health­care plat­form as pre­sent­ed were to be ful­ly imple­ment­ed under a future Pres­i­dent Biden, it would amount to a sig­nif­i­cant improve­ment on the sta­tus quo — albeit with per­sis­tent gaps that can’t be resolved with­out abol­ish­ing pri­vate health insur­ance as it’s cur­rent­ly constituted.

The rec­om­men­da­tions front-load a tem­po­rary phase of coro­n­avirus-relat­ed emer­gency mea­sures, many of which have emerged as con­sen­sus demands from Democ­rats — includ­ing free coro­n­avirus test­ing irre­spec­tive of immi­gra­tion sta­tus, fed­er­al­ly-bankrolled expan­sion of con­tract trac­ing, and a peri­od of 100% pre­mi­um sub­si­dies for those eli­gi­ble for COBRA cov­er­age through­out the dura­tion of the pan­dem­ic. The doc­u­ment also calls for a spe­cial enroll­ment peri­od for ACA mar­ket­places, which will include a stop­gap low-fee plat­inum option for peo­ple who run out of, or don’t qual­i­fy for, sev­er­al months of full COBRA subsidies.

More broad­ly, the task force seeks to rein­vest in crit­i­cal pub­lic health infra­struc­ture at the local and state lev­el, much of which was finan­cial­ly hol­lowed out dur­ing the Great Reces­sion and has been left in dis­re­pair since. It also calls for per­mit­ting Medicare to nego­ti­ate pre­scrip­tion drug prices, fund­ing for research into racial health inequities, repeal­ing the Hyde amend­ment and secur­ing pro­tec­tions for LGBTQ peo­ple that were rolled back under Pres­i­dent Trump.

The task force also advances a blue­print for a pub­lic option, which includes crit­i­cal details that ges­ture toward left-wing activist pres­sure, as well as ambi­gu­i­ties that could bol­ster the sort of prof­it-seek­ing games­man­ship that ren­ders the cur­rent sys­tem so dysfunctional.

For starters, the pro­pos­al hints that the pub­lic option may actu­al­ly be a set of options, à la Medicare, which offers con­sumer choice” while in prac­tice curb­ing access to care while lin­ing insur­ers’ pock­ets. Still, accord­ing to the pro­pos­al, at least one pub­lic option plan avail­able on the mar­ket­places must be pub­licly admin­is­tered and have zero deductibles, which is far prefer­able to the kind of pri­vate­ly-admin­is­tered pub­lic option advan­tage” plans these rec­om­men­da­tions leave the door open to. The pub­lic option, as laid out here, would also be extend­ed for zero pre­mi­ums to indi­vid­u­als who qual­i­fy for Med­ic­aid but live in non-expan­sion states, auto­mat­i­cal­ly enroll low-income peo­ple who earn too much for Med­ic­aid, and be avail­able as an alter­na­tive to employ­er-based cov­er­age. Mean­while, the Medicare eli­gi­bil­i­ty age will be low­ered from 65 to 60, and bar­ri­ers will be low­ered for states seek­ing waivers to build state-based sin­gle-pay­er programs.

All of these changes would be an improve­ment upon the health­care sys­tem as it exists now, an abysmal­ly low bar that Repub­li­cans are nonethe­less des­per­ate to lim­bo beneath. In the wake of their unsuc­cess­ful attempts to repeal and replace the ACA in 2017, the GOP has con­sis­tent­ly chipped away at the law how­ev­er pos­si­ble, through push­ing Med­ic­aid work require­ments, bot­tom­ing out bud­gets for nav­i­ga­tors and adver­tis­ing to help inform and guide patients through enroll­ment, and loos­en­ing restric­tions on short-term junk plans. Even more grave­ly, the Trump admin­is­tra­tion recent­ly encour­aged the Supreme Court to strike down the entire ACA.

But assess­ing just how much Biden’s task force’s plan would improve the lives of patients depends on details we sim­ply don’t have. The pro­pos­al stip­u­lates that pre­mi­ums will be capped at 8.5% of income (more for a fam­i­ly), which could poten­tial­ly mean that a slate of rel­a­tive­ly robust pub­lic option plans would force pri­vate plans to improve sub­stan­tial­ly to com­pete. Or, more like­ly, pri­vate insur­ers could take a cue from Medicare Advan­tage and find ways to cher­ry-pick health­i­er patients while off-load­ing sick­er ones onto the pub­lic program.

Cost-shar­ing is also par­tial­ly unre­solved — a pub­lic option plan with zero deductibles, for exam­ple, may well entail high­er copays and coin­sur­ance, per­haps going so far as to foist enrollees into pri­vate sup­ple­men­tal plans par­al­lel to Medi­gap” cov­er­age for Medicare recipients.

Fur­ther­more, the cru­cial issue of provider net­works goes unmen­tioned. As net­works have nar­rowed in recent years with insur­ers try­ing to save mon­ey by cov­er­ing few­er and few­er providers, many ACA plans have failed to ade­quate­ly cov­er cer­tain types of care, like men­tal health. Tra­di­tion­al Medicare, by con­trast, doesn’t have net­works and thus affords patients free choice of providers. What kinds of ben­e­fits and cost-shar­ing will be applied to which pub­lic option plans will make a world of dif­fer­ence — and will require even more exper­tise to suss out than the noto­ri­ous­ly con­fus­ing ACA exchanges already do.

Ulti­mate­ly, how­ev­er beefy a pub­lic option turns out to be, there are things it can nev­er do. By offer­ing one more insur­ance prod­uct to a list of sev­er­al oth­ers — even if it’s the best of the bunch — the pub­lic option does lit­tle to alle­vi­ate the mis­ery of nav­i­gat­ing the admin­is­tra­tive quag­mire endem­ic to our health­care sys­tem. It still leaves gaps for patients to fall into, and forces them to beg claims asses­sors for cov­er­age by phone. And it still casts us as health­care con­sumers, shop­ping for the best-val­ued access to a foun­da­tion­al human need that shouldn’t be com­mod­i­fied to begin with.

Natal­ie Shure is a Los Ange­les-based writer and researcher whose work focus­es on his­to­ry, health, and politics.
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