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‘Medicare for All’ can mean at least two different things

One of them would be a much bigger, and, to some people, much scarier change than the other.

Sen. Kamala Harris, D-California, says that she absolutely favors a “Medicare for All” program.
Sen. Kamala Harris, D-California, says that she absolutely favors a “Medicare for All” program.
REUTERS/Elijah Nouvelage

The slogan “Medicare for All” can mean two things. Well, at least two. One of them would be a much bigger, and, to some people, much scarier change than the other. But the two meanings are both out there, which isn’t really helpful but makes it necessary to clarify the two ideas.

Sen. Kamala Harris, D-California, who is considered a top contender for the Democratic nomination for president in 2020, gave a CNN televised town hall forum Tuesday night. She came across as strong, smart and brave. But my feelings about the “brave” part was undermined when I subsequently read about a small maneuver she employed to fuzz up her position on the future of health care.

In response to a question, Harris said that she absolutely favors a “Medicare for All” program. Her words suggested that she meant the version of “Medicare for All” that completely replaces and eliminates private health insurance and replaces it with what is sometimes called “single payer.”

But maybe not. Let me try to clarify/explore a few terms, because we’ll hear a lot about this matter as next campaign develops.

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Under “socialized medicine,” pretty much all health care facilities are owned and operated by the government and health care providers are government employees. All citizens are covered. This is what they have in England. At present, full-bore “socialized medicine” is not part of the mainstream American policy discussion.

Under “single payer,” doctors and nurses are not all government employees and the federal government doesn’t own all the hospitals, but government pays all or most medical bills, which greatly reduces or eliminates the need for private health insurance.

Medicare is a single-payer system, but, of course, it doesn’t cover us until we hit age 65. The United States is among a small minority of wealthy nations in not having either of these systems (except for seniors, via Medicare, and the poor, via Medicaid).

America has long been nervous about anything that can be called “socialism,” and Republicans are adept at turning any discussion of increasing government’s role as a step toward socialism. “Socialized medicine” is a nonstarter in U.S. politics, used only as a club to pummel anything that increases the government’s role.

Versions of “single payer” also used to be considered politically suicidal, but that’s changing. Bernie Sanders is for single-payer, has been for years, which is among the reasons many handicappers assumed his chances for the 2016 presidential nomination were low. But they were wrong. Sanders came close. One reason, perhaps, is that he adapted his language to refer to the single-payer approach as “Medicare for All.”

In American politics, “socialism” is a bad word, “Medicare” is a good word. And I’d say our political culture is in a period of transition of how scary the term “single payer” is, and how powerful a tool it will be for the right to label all liberal ideas “socialism.” But that power isn’t gone, so Republicans pounced on what Harris said on CNN about Medicare for All to gin up the red menace.

“Medicare for All,” on the other hand, currently has two meanings. It may mean that private insurance goes away, the federal government pays all the bills, but the federal government would also, of course, have to decide what was covered. If you like your current private or employer-subsidized health insurance, you might be worried that “Medicare for All” might not pay for all the benefits you are currently getting.

But it turns out that there is a less radical, perhaps less-scary version of “Medicare for All,” because it is optional. Under this version of “Medicare for All,” all Americans, including those under 65, would have the option of buying into Medicare, if they choose, but would also have the option of keeping their private health insurance. It’s a Medicare option for all, but those who preferred their current private insurance could stay put. And Harris is apparently for that, too, although you wouldn’t have known that if you had only heard what she said on CNN.

This CNN story about Harris’ town hall forum includes a video clip of that exchange at the top. A woman from the audience asks Harris specifically whether she favored a health care solution that would “cut private insurance companies, as we know them, out of the equation.”

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Harris replied: “I believe the solution … is that we need to have Medicare for All. That’s just the bottom line.”

The audience applauds. But there was nothing in the exchange to even hint that Harris might be referring to either of two ways of reaching the goal, one of which would phase out the private health insurance industry, and one of which would not.

I don’t mean to overdo the notion that Harris was deceiving, but she does seem to want to have it both ways without making that clear. The Medicare “option” for all plan might be great.

David Leonhardt of the New York Times used his daily email yesterday to clarify this. He did a good job. Harris’ staff explained the two versions of what might be called “Medicare for All,” and said that she favors both, but that the more radical approach that would make Medicare universal is “what she’s running on.”

I don’t want to overdo how dishonest her answer might have been. She didn’t exactly lie, but her answer seemed too cute, and meant to deceive. She should have said something like: “I favor making Medicare available to every American who wants it. There’s a bill in Congress that would do that by making a Medicare buy-in available to every American, while leaving the private health insurance industry to compete with that option. And there’s a bill that would do it by making Medicare universal for all Americans, which would mean the end of the private health insurance as we have known it. As president I would sign either of those bills. The goal is to have every American insured.”