Health Care Plans Are Duking It Out in the Democratic Primary

Miguel Juarez Lugo/ZUMA

The Washington Post declares today that enthusiasm for full-blown Medicare-for-All is waning:

Democrats back off once-fervent embrace of Medicare-for-all

Leaning back on a black leather sofa as her campaign bus rumbled toward Fort Dodge, Kamala D. Harris tried to explain why she spent months defending a plan to replace private health insurance with Medicare-for-all, only to switch to a more modest proposal that would allow private insurance to continue after all.

“I don’t think it was any secret that I was not entirely comfortable — that’s an understatement,” Harris said, holding a to-go cup from a Mexican restaurant at a recent stop. “I finally was like, ‘I can’t make this circle fit into a square.’ I said: ‘We’re going to take hits. People are going to say she’s waffling. It’s going to be awful.’ ” But, she said, she decided it was worth it.

So what is Harris’s plan these days? Here’s the nutshell version:

  • Anyone can immediately buy into Medicare, which will be improved in various ways.
  • A 10-year phase-in of an expanded Medicare for newborns and the uninsured.
  • Allow private insurers to offer coverage similar to today’s Medicare Advantage program.
  • “At the end of the ten-year transition, every American will be a part of this new Medicare system. They will get insurance either through the new public Medicare plan or a Medicare plan offered by a private insurer within that system.”

That’s fine. I have no argument with any of it. However, it leaves out a big issue: how much will people have to pay for it? Is it literally free, paid for entirely by taxes? Or do consumers have to pay an annual premium? Does the premium increase with income, like Obamacare? If so, what’s the top premium level? And what are the caps on copays, deductibles, and out-of-pocket expenses?

The truth is that Obamacare could basically be fixed with a couple of simple changes:

  • Higher premium subsidies all the way through the middle class, including an absolute cap of 8 percent of income no matter how rich you are.
  • Stricter rules on deductibles and OOP, which would also apply to private plans.
  • Add a public option to buy in to Medicare.

That’s it. There are other things it would be nice to fiddle with, but those three would turn Obamacare into something very, very close to a national health care plan. Whether you prefer this to Harris’s plan or Sanders’ plan is, frankly, more a matter of personality and mood than it is of actual dedication to the best possible health care. All three of them would work fine.


In 2014, before Donald Trump announced his run for president, we knew we had to do something different to address the fundamental challenge facing journalism: how hard-hitting reporting that can hold the powerful accountable can survive as the bottom falls out of the news business.

Being a nonprofit, we started planning The Moment for Mother Jones: A special campaign to raise $25 million for key investments to make Mother Jones the strongest watchdog it can be. Five years later, readers have stepped up and contributed an astonishing $23 million in gifts and future pledges. This is an incredible statement from the Mother Jones community in the face of the huge threats—both economic and political—against the free press.

Read more about The Moment and see what we've been able to accomplish thanks to readers' incredible generosity so far, and please join them today. Your gift will be matched dollar for dollar, up to $500,000 total, during this critical moment for journalism.

We Recommend


Sign up for our newsletters

Subscribe and we'll send Mother Jones straight to your inbox.

Get our award-winning magazine

Save big on a full year of investigations, ideas, and insights.


Support our journalism

Help Mother Jones' reporters dig deep with a tax-deductible donation.


We have a new comment system! We are now using Coral, from Vox Media, for comments on all new articles. We'd love your feedback.