In keeping with the established tradition of inaugural addresses, Joe Biden’s speech on Wednesday was heavy on adornment and light on specifics — closer to high mass than a press conference or policy brief. One line, however, provided a somewhat ominous clue as to how the new administration expects to move on a critical policy area, namely health care reform: “We can reward work, rebuild the middle class,” Biden declared from atop the inaugural platform, “and make health care secure for all.”
As anyone who has followed the broader health care debate closely should instantly recognize, words like “secure” often signal distance from any ambitious reform effort. Like “affordability” or “access,” it’s the sort of vague conceit centrist Democrats like to invoke in lieu of embracing transformative or clearly articulated policy ideas. Biden, unlike his vice president, has never even pretended to support a Medicare for All, single-payer system as an alternative to America’s broken status quo — even telling one interviewer last spring that he would veto M4A legislation even if it passed both the House and the Senate.
Nevertheless, Biden’s campaign officially committed him to pursuing a public option (that is, a nonmandatory government-run alternative to privately provided health insurance, for which most people would qualify). If nothing else, such a course would represent a break with the current model and, depending on the details, could result in a more than negligible improvement. Biden’s plan, at least as written on his still-active campaign website, is not without some very obvious problems. For one thing, even if implemented to the tee, it would still leave roughly ten million people uninsured. As Libby Watson explained last October, significant questions also remain unanswered about how the public option would work in practice — its actual mechanics being incredibly vague.
The bigger issue, at least for the moment, is that Biden’s pledge to make health care “secure for all” doesn’t sound much like the kind of rallying cry likely to precede large-scale health care reform. Still more worryingly, his recently announced COVID-19 relief plan adopts language from a letter sent to lawmakers by health insurance lobby groups. As Andrew Perez and Julia Rock explain:
Biden’s plan would shovel billions of dollars to private health insurers by providing [increased] subsidies for Americans to buy coverage through the Affordable Care Act (ACA) marketplaces, which are far more expensive than government healthcare programs and have at times been plagued by high rates of claim denials. The plan would also subsidize COBRA continuation coverage through September, allowing workers to keep their employer health insurance plans when they’re laid off. Those initiatives — which could further boost insurers’ skyrocketing profits — were recently recommended in a letter to lawmakers from America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association, two insurance lobby groups in Washington that have opposed the expansion of government-sponsored healthcare programs.
It’s possible, of course, that Biden’s team considers this an interim measure and is planning for a more aggressive reform push somewhere down the road, though the preceding isn’t a particularly encouraging sign that one is coming.
Though the likelihood of single-payer legislation even reaching the floor of the House anytime soon admittedly seems very faint, one very basic fact remains inescapable: Medicare for All still represents the simplest, most efficient, and egalitarian option there is — the only one, in fact, to genuinely reflect the principle officially inscribed in the Democratic platform: “As Democrats, we fundamentally believe health care is a right for all, not a privilege for the few.”
Even with a public option, millions would probably remain uninsured, and millions more would almost certainly face bureaucratic headaches and other obstacles to enrollment. There’s also a very real risk it would end up functioning more as a bargain-basement alternative for people unable to buy insurance or get employer-based plans — effectively enshrining one kind of care for those able to afford it and another for everyone else.
Medicare for All, by contrast, entails minimal bureaucratic or financial obstacles for the average person — which is probably one reason Medicare as it currently exists is so consistently popular. A majority of Americans, in fact, already support it, as do big majorities of citizens in countries like Canada and the UK which already have some form of universal public provision.
Forget making health care “affordable,” “accessible,” or “secure.” If Democrats actually believe it constitutes “a right for all, not a privilege for the few,” they should use their newly secured congressional majority to make health insurance national, universal, and free.