Health Care

Peter Suderman | From the November 2024 issue

Kamala Harris' most notable foray into health care policy was when she endorsed an idea she now says she doesn't support.

In 2017, she co-sponsored a single-payer health care plan developed by Sen. Bernie Sanders (I–Vt.). That plan would have cost about $30 trillion, by many estimates, and would have eliminated virtually all private insurance, replacing it with a single government-financed plan.

When Harris campaigned for the Democratic presidential nomination in early 2019, she initially proposed a plan along those lines and gave interviews backing the elimination of current private health insurance arrangements. The backlash was swift and strong, and so was Harris' reversal. Within a few months, Harris had backed away from single-payer, touting a new, less detailed plan that would have expanded government-run health coverage without erasing private coverage.

With sagging poll numbers, Harris dropped out of the Democratic nomination contest before the first primary even took place. Among the reasons her candidacy flopped was that she was seen, even by some Democrats, as a flighty figure prone to politically convenient about-faces.

Now that she has climbed to the top of the Democratic ticket, it is once again worth asking what her approach to health care policy actually is. Given that she served as vice president under President Joe Biden, the best way to understand it is probably to look at Biden's approach to health care policy.

When Biden campaigned for the Democratic presidential nomination in 2019 and 2020, he also faced questions about single-payer, sometimes called Medicare for All. But he defined his approach to health care more by what he wouldn't do than by what he would.

Biden's chief antagonist in the race was Sanders, and arguably the most prominent policy dispute between them was over Medicare for All. Sanders was for single-payer. Biden was against it.

Medicare for All, Biden said, would cost too much and would deprive people of health plans that work right now. Asked whether he would veto Medicare for All legislation should it come to his desk as president, Biden responded carefully, saying: "I would veto anything that delays providing the security and the certainty of health care being available now." It wasn't quite a promise to veto Medicare for All, period. But it was a strong signal that he wouldn't back the plans Sanders supported.

So what was Biden's preferred approach to health care? Rather than wiping out the current system, Biden favored a more incrementalist approach. Biden's priority, a campaign spokesperson told the press, was to move toward universal coverage. Biden wanted to "build on the profound benefits of the Affordable Care Act."

Practically and politically, Medicare for All was never really on the table, not even in a potential Sanders administration. The cost was too high. Even among Democrats, the votes simply weren't there. To a great extent, the debate was a proxy fight—a policy hypothetical allowing the candidates to sharpen their public personas. The upshot was clear enough. Sanders was a single-payer supporter, a radical, an American socialist; Biden was just a garden-variety big-government liberal.

At the time, Biden's campaign said he supported a "Medicare-like public option," essentially a government-run plan intended to exist alongside America's current mix of private and public health financing systems. But the core of his campaign's answer was the invocation of the Affordable Care Act, more commonly known as Obamacare.

When Obamacare became law in 2010, Biden was vice........

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