If we are going to keep having these grim circuses that we call debates, and begin each one with an extended segment about health care, it would be nice if we could stop asking the same questions again and again—but what about taxes?—and try to pin the leading candidates down on the specifics of their plans. They could ask Kamala Harris why anyone would keep their employer insurance if her Medicare plan would limit out-of-pocket spending to $200, or ask Bernie Sanders how a Medicare For All system would decide what to cover. But it’s the frontrunner who is most in need of a grilling, because lately he has seemed incapable of discussing any health care plan, including his own, with any accuracy.

Joe Biden says his plan will “guarantee that everyone will be able to have affordable insurance.” It is impossible to say that his plan will accomplish this. Biden’s plan would increase subsidies on the Affordable Care Act marketplace and lower the premium limit on marketplace plans from 9.86 to 8.5 percent of annual income. As Julián Castro noted, to Biden’s head-shaking, Biden’s own website says it would leave three percent of Americans uninsured, or more than 10 million people. It’s also pretty laughable to assert that lowering the premium limit to 8.5 percent and pegging subsidies to Gold instead of Silver plans will “guarantee” that everyone’s coverage will be affordable, particularly when this only applies to marketplace plans that cover just 11 million people.



Biden’s plan would limit deductibles to $1,000—which, while better than the astronomical deductibles millions have today, would certainly not be affordable for many families to pay in one go—but doesn’t appear to have any mechanism to lower employer-based plan premiums, which continue to rise. (Indeed, it’s hard to imagine that insurers wouldn’t dramatically raise premiums if deductibles were limited; another great reason to get rid of insurers entirely.) And merely promising “affordable insurance” is not enough, of course, when so many expenses are incurred even with affordable insurance, such drug costs and out-of-network bills.



Some health care concepts seem to escape him entirely. When pressing Sanders on the cost of his plan, Biden said that Sanders’s plan promised “a deductible in your paycheck.” This does not make sense. Clearly, he means a tax or a premium, but this is at least the second time he’s said this, and his team pushed the line out on Twitter as well. It is troubling that his proficiency with the jargon of health care financing is so loose after many months of campaigning, let alone after eight years of being vice president in the administration that passed the Affordable Care Act.



The oddest moment arose during a discussion as to whether Biden’s plan would “automatically” cover people. Sanders insisted that his plan was the “only one” that would prevent people going into “financial ruin because they suffered with a diagnosis of cancer.” Biden, as is his wont, said cancer was “personal” to him, and objected to Sanders’s contention: “Every single person who is diagnosed with cancer or any other disease can automatically become part of this plan. They will not go bankrupt because of that. They will not go bankrupt because of that. They can join immediately.”

