The Democrats’ ‘Medicare for All’ debate finally begins in earnest

Sen. Kamala Harris (D-Calif.) caused a bit of a stir this week at a town-hall forum in Iowa, where she told CNN’s Jake Tapper that in her “Medicare for All” model, private insurers would eventually not be a part of the health care system. There are competing approaches to implementing a “Medicare for All” model, and the California Democrat is now bringing her reform vision into focus.

To be sure, this didn’t come as too big of a surprise. Harris is a co-sponsor of Sen. Bernie Sanders’ (I-Vt.) single-payer legislation, and she explained her position in her new book. Still, given Harris’ role as a leading White House contender, it was notable to hear her lay down a marker of sorts on one of her party’s most important priorities.

A likely rival for the Democratic Party’s 2020 presidential nomination, Michael Bloomberg, pushed back against Harris’ idea yesterday, insisting it would “bankrupt” the country.

Mr. Bloomberg, the former New York City mayor who is considering a 2020 bid on a centrist Democratic platform, rejected the idea of “Medicare for all,” which has been gaining traction among Democrats.

“I think you could never afford that. You’re talking about trillions of dollars,” Mr. Bloomberg said during a political swing in New Hampshire, which holds the nation’s first primary in 2020.

“I think you can have ‘Medicare for all’ for people that are uncovered,” he added, “but to replace the entire private system where companies provide health care for their employees would bankrupt us for a very long time.”

There are three things about this I consider important. The first is, Bloomberg may be running as a centrist (and former Republican), but that makes it all the more striking that he’s comfortable with a “Medicare for All” model for those currently without coverage. In effect, the former mayor sounded yesterday as if he’s prepared to accept an ambitious public option as a middle ground behind Harris’ proposal and the Affordable Care Act, which largely drives the uninsured into the private health care marketplace.

A decade ago, this was considered an ambitious progressive goal. In 2019, it’s what the centrist candidate in the Democratic field is comfortable with. It’s emblematic of just how much the health care debate has changed in a fairly short period of time.

Second, as someone who’s been heavily invested in the political debate over health care, I don’t mind admitting how exciting it is to see this debate unfold in earnest. Putting aside the Harris-vs-Bloomberg aspect, we’re starting to see a substantive argument about whether and how to vastly expand Americans’ access to a Medicare-like system.

It wasn’t long ago when this debate was a pipe dream. Now, it’s very much a reality.

And third, Bloomberg is approaching this argument the wrong way, as I suspect he’ll soon learn.

There are perfectly legitimate arguments against a “Medicare for All” system. Every reform model has advantages and disadvantages, and there’s nothing wrong with acknowledging the tradeoffs that are unavoidable.

But to condemn a “Medicare for All” model because it features “trillions of dollars” is a mistake. The awkward truth is simple: in the coming decades, the United States is going to spend tens of trillions of dollars on health care. Period. Full stop. That will be true if we leave the existing system in place; it will be true if Republicans successfully destroy the Affordable Care Act; and it will be true if Democrats successfully overhaul the system into a more single-payer-like approach.

The real debate is over how those tens of trillions of dollars will be spent and how policymakers will create a framework to maximize the applied benefits.

Regular readers may recall that the right recently got very excited about a study from Charles Blahous of the Mercatus Center at George Mason University, who took a critical look at Bernie Sanders’ “Medicare for All” plan. The examination put a price tag on the proposal — $32.6 trillion — which conservatives considered proof that such a system would be prohibitively expensive.

The trouble, of course, was that the same study ended up suggesting that the United States would actually spend less under a “Medicare for All” model than we would under the existing system.

If Bloomberg wants to make the case against this reform plan, he’ll need to think of something else.