Biden-Harris debate rematch highlights health plan differences

Which of these Democrats can insure more Americans?

As Wednesday’s debate made vividly clear, there are almost as many versions of Medicare for All as there are Democratic candidates — and each one thinks their plan is the path to insuring every American.

For California Sen. Kamala Harris and former Vice President Joe Biden, health care became the sequel to their first fiery exchange — when Harris, peering over at Biden, movingly recalled during the first round of debates how the bussing policy he once backed had changed the course of her life.

This time they were in Detroit, joined for the second night of this second round of Democratic primary debates by New Jersey Sen. Cory Booker and seven other presidential hopefuls.

Though only two candidates referenced health care in their opening remarks -- former Housing and Urban Development Secretary Julian Castro, who also served as the mayor of San Antonio, Texas; and New York Sen. Kirsten Gillibrand -- there was another elephant in the room: Medicare for All.

For about 24 minutes, nearly a quarter of the debate, the 10 Democrats wrestled for control of health care. They batted around arguments for why their version of a government plan would bring Americans universal health coverage. They cited the hefty profits of the insurance and pharmaceutical industries as a critical symptom of the system’s ills.

Harris was confident in outlining her version of Medicare for All, saying she listened to Americans to create an approach that would respond to their needs. This would include a public option and a 10-year transition to a new Medicare-based system.

But Biden quickly hit back, saying that when someone promises something in 10 years, you have to wonder why it will take so long. He reiterated his support for the Affordable Care Act, saying it is working and the best way forward is to "build on what’s working."

They bickered over how to retain consumer choice, using terms like private and employer-based insurance, public option and Medicare Advantage.   

New York City Mayor Bill de Blasio puzzled over the "mythology that people are in love with their private insurance." Washington Gov. Jay Inslee boasted that his state just became the first to provide its citizens with a public option. Biden boldly repeated his version of the claim very similar to the one that earned President Barack Obama PolitiFact’s 2013 Lie of the Year.

At times the back and forth was fast and furious, and it seemed even the candidates were lost in the numbers they were firing across the stage. Fortunately, we were taking notes.

HARRIS: "I'm going to go back to Vice President Biden because your plan does not cover everyone in America by your staff’s and your own definition. Ten million people, as many as 10 million people, will not have access to health care."

Her claim needs, at least, further scrutiny. 

When Biden unveiled his health care plan a couple weeks ago, his campaign noted — under the bold heading, "Give Every American Access to Affordable Health Insurance" — that it would insure "more than an estimated 97 percent of Americans."

Vermont Senator Bernie Sanders, who is also running for the Democratic presidential nomination, first proposed the Medicare for All plan. His campaign initially seized on that figure on Monday, arguing that that would leave about 10 million people uninsured.

A Harris campaign spokeswoman pointed to the fact that there are an estimated 329.3 million people in the United States, and three percent of the total population would be about 9.88 million people.

Imprecise math aside, there are other factors that could play into the number of uninsured individuals under a Biden health care system. That includes the fact that some Americans just don’t want insurance — the problem the Affordable Care Act’s individual mandate was intended to fix. But Republicans in Congress repealed the penalty for that mandate.

COLORADO SEN. MICHAEL BENNET: "I believe we should finish the job we started with the Affordable Care Act with a public option that gives everybody in this audience the chance to pick for their family whether they want private insurance or public insurance and requires drug companies to be negotiated with by Medicare and it provides competition. That is totally different from the plan that Sen. Warren and Sen. Sanders and Sen. Harris have proposed, which would make illegal employer-based health insurance in this country."

Both Bennet and Biden claimed Harris’ plan would lead to the elimination of employer-based insurance. That could be the case, particularly for plans that would not meet the expansive requirements for coverage of "medically necessary" services Harris outlined.

But there is more to learn about Harris’ plan, released just two days ago — and at least a couple problems with Bennet’s claim.

To start, while Warren, Sanders and Harris all use the term "Medicare for All" to refer to their preferred health care plan, they do not share a single plan.

The Sanders plan (endorsed by Warren) would eliminate private insurance in favor of a government plan. Harris’ plan, though, keeps a role for private insurers willing to offer Medicare coverage that meet certain benefit and cost requirements.

 During her plan’s decade-long phase-in, Harris wrote in a Medium post — and Bennet’s campaign cited as evidence — that it would "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."

Would those employer plans transition out of existence? Harris’ campaign did not immediately respond to inquiries about the future of employer-based insurance under her proposal.