Kamala Harris isn't just abandoning single-payer health care, but support for any form of universal health care.

The media is getting this wrong.

Amidst the ongoing debate over Vice President Kamala Harris lacking a policy platform, I want to turn attention to her past health care positions. Health costs remain a top financial stressor according to Gallup polling, the uninsured rate is rising again, millions of poor children are losing Medicaid coverage, and the percent of American adults skipping medical treatment due to cost concerns was at the same level as 2015 last year. Given these alarming trends, one would expect Harris to revive her 2019 universal health care plan, but instead she appears to be entirely abandoning past support for universal coverage. The public, however, doesn’t seem aware of this, because the media is misreporting her 2019 plan and ignoring her current position. To understand this complicated situation, some context and history are needed.

Rising numbers of U.S. adults are skipping medical treatment due to costs.

First, it’s important to properly define universal health care — the WHO refers to it as “universal health coverage” — given widespread confusion among the American public:

Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care.

This means that, clearly, the Affordable Care Act status quo is very far from universal health care. Tens of millions of Americans remain uninsured and others with insurance can’t actually access the care they need, either because they are underinsured or can’t find doctors and clinics where they live.

Second, a little history: in 2019, as the Democratic primary got underway, universal health care became the most important policy issue. There was broad recognition that, while Obamacare had made things better (e.g. partial Medicaid expansion, ending medical underwriting, etc.), there was a need to — let me borrow Joe Biden’s catchphrase — “finish the job” on health care reform. (Biden himself proposed a health care policy that barely qualified as universal health care and included a “Medicare-like public option,” which he has not mentioned since 2020.)

Kamala Harris, who would eventually drop out of the race in December 2019, responded to this political and health policy context by proposing a managed-competition universal health care plan labeled “Medicare for All,” which would have gradually achieved universal coverage over a decade of implementation. This was something of a tactical retreat from her 2017 support for Bernie Sanders’ single-payer bill. Unlike a single-payer system — where one national insurance fund pays medical bills to a mix of public and private providers — a managed-competition system preserves private insurers and they compete for customers. The government then tightly regulates the insurers and helps them to remain solvent, even if they have a lot of expensive (i.e. very sick) enrollees in a given year, by deploying risk-adjustment mechanisms.

This is all essential to understand, because the media is now erroneously reporting that Harris is abandoning support for single-payer health care this summer when she actually abandoned support for single-payer in 2019 by proposing the aforementioned insurance-based health policy. Look at a recent New York Times story entitled “Why the Kamala Harris of Four Years Ago Could Haunt Her in 2024” (emphasis mine):

In addition to changing her position on fracking, campaign officials said she now backed the Biden administration’s budget requests for increased funding for border enforcement; no longer supported a single-payer health insurance program; and echoed Mr. Biden’s call for banning assault weapons but not a requirement to sell them to the federal government.

Americans — even highly educated journalists, political operatives, and policy wonks who should know better — often discuss single-payer and universal health care as interchangeable, ignoring that many countries (e.g. Japan, Germany, Netherlands, Switzerland) achieved universal coverage decades ago with insurance-based systems. This confused reporting is therefore unsurprising, but it’s problematic insofar as it lets Harris off the hook for withdrawing support for universal health care. Again, she stopped supporting single-payer in 2019 when she introduced her managed-competition plan improperly branded as Medicare for All. Now in 2024, she’s disowning that insurance-based universal health care proposal, which the media inaccurately refers to as single-payer, and instead embracing modest reforms to the Affordable Care Act that won’t even come close to something resembling the universal health care systems present in other high-income countries. (For example, the Dutch have a managed-competition system and the standard deductible is €385, though cost-sharing and deductibles don’t apply to children. Some Obamacare deductibles now approach $20,000 for family plans and $10,000 for individual ones.)

For the “center-left” presidential candidate to effectively abandon past support for universal health care in a country where the poor and marginalized, even the middle-class, are routinely denied access to modern medicine or bankrupted by the cost of care is a notable development. It is a dramatic reversal of the Democratic Party’s 2020 approach to health care and, frankly, nearly a century of Democratic work to achieve universal health coverage.

In 1962, while speaking about the moral urgency of establishing a national health insurance program, John F. Kennedy told an audience at Madison Square Garden that “the fact of the matter is that what we are now talking about doing, most of the countries of Europe did years ago, the British did it 30 years ago, we are behind every country pretty nearly in Europe, in this matter of medical care for our citizens.”

It has now been 76 years since the British launched their National Health Service. We are also over 40 years behind the Italians, who launched a universal health care system in 1978. Indeed, the U.S. lags behind all other high-income countries on universal health care — this used to be a key Democratic message during presidential campaigns!

One could perhaps understand Harris’ approach if universal health care was unpopular, but there is actually majority support (63%) for single-payer in the swing states that Harris must win to deny Donald Trump a second term. And that’s support for a pure single-payer program, not the more moderate insurance-based universal system Harris proposed in 2019, which would be harder for Republicans to attack as “socialism” or “eliminating private health insurance.”

If Harris does an interview before the end of the month as promised, she should explain why she no longer supports universal health care, despite it being politically popular in swing states and an effective policy for improving public health and addressing the cost-of-living crisis.