Why Democratic Presidential Candidates Are Eager To Talk About Health Care

Democratic candidates are offering competing visions for how to tweak or overhaul the nation's health care system ahead of this week's presidential debate.

RACHEL MARTIN, HOST:

Democrats are eager to talk about health care. It was their strategy to win back the House of Representatives last year. And ahead of this week's presidential debate, the candidates are talking a lot about how to change the nation's health care system. And this morning, California senator Kamala Harris released her plan to implement Medicare for All. NPR's Danielle Kurtzleben has been digging into the details and joins us now. Hi, Danielle.

DANIELLE KURTZLEBEN, BYLINE: Hey, Rachel.

MARTIN: What's in the plan?

KURTZLEBEN: So Kamala Harris is proposing what she's calling her version of Medicare for All - Medicare for All, of course, being that plan that Senator Sanders has unveiled multiple times over the years. Now, Kamala Harris' plan wouldn't be government-administrated insurance for everyone. Under her plan, there would be a Medicare-like program administered by the government that people could enroll in. And, like traditional Medicare, it would be an - a plan operated by the government.

But what sets her plan apart is another thing that is like how Medicare is now. There would be the option to get Medicare plans on the private market. Right now, we call that Medicare Advantage. A lot of seniors are enrolled in that. This would do something like that for everyone.

But also, one thing to keep in mind here also is that Medicare for All has been very effective branding for Democrats, but a lot of these plans, not exactly an expansion of Medicare to everybody. Because Harris' plan, for example - much more expansive than Medicare. It covers reproductive health, vision, dental, so not exactly like traditional Medicare that people are used to.

MARTIN: Right. So if it's more expansive, does that mean it is more expensive?

KURTZLEBEN: (Laughter).

MARTIN: I mean, Harris has said she wouldn't raise taxes on the middle class to pay for this. But Vice President Joe Biden thinks otherwise.

KURTZLEBEN: Right.

MARTIN: Let's listen to what he had to say last week.

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JOE BIDEN: Well, I find that people will say they're for Medicare for All, but they're not going to tax the middle class because you don't need to do that. Come on. What is this - this a fantasy world here?

MARTIN: So would Kamala Harris raise taxes to pay for this?

KURTZLEBEN: She would raise taxes, but she has said that she wouldn't have to raise taxes on the middle class. And this is one area where she really contrasts with Bernie Sanders' Medicare for All plan. He has proposed a 4% tax on any household with income over 29,000. Her plan would bring that threshold up to 100,000. So yeah, a bunch of middle-class households who wouldn't be paying that tax. And to make up for that revenue, she has said that there would be other ways to get that. She has proposed taxes on financial transactions like stock and bond and derivative trades.

MARTIN: Is there a way to understand whether or not Kamala Harris' plan would bring down the cost of health care overall?

KURTZLEBEN: So her team didn't provide detailed math on exactly whether this would bring down total national health care costs. Now, experts do say that big overhaul plans like this, like Senator Sanders' Medicare for All overhaul, they could bring down total national costs. But the devil is in the details, as we always say. It would just depend on so many things about this proposal. So we're definitely going to be watching independent analysts, think tanks who you can imagine - you can bet - will be coming out with their own estimates of this.

Now, voters of course will be more concerned about how much they will be paying. And one thing to keep in mind with big overhaul plans like this is that households might have higher taxes to pay. But that doesn't necessarily mean their overall costs will be higher because, in many of these cases, those taxes will take the place of premiums.

MARTIN: So you mentioned earlier that there will be some kind of role for private insurance...

KURTZLEBEN: Right.

MARTIN: ...In the Harris plan. She's gotten into some hot water because she's given mixed messages about this. So can you clarify what the private insurance role is?

KURTZLEBEN: Yeah. Yes. So she will have private insurance in her plan. We now know that definitively. And it would be those Medicare Advantage-like plans that I mentioned earlier. And that is maybe the biggest difference between her plan and Senator Sanders' Medicare for All proposal, which wouldn't even allow private plans that would duplicate government coverage. So under his plan, that would leave very little room for private insurers - for her, plenty of room.

MARTIN: NPR's Danielle Kurtzleben, thank you so much.

KURTZLEBEN: Thank you.

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