Joe Biden has released a health care plan. It’s an interesting plan, and worth taking a careful look at, because it is likely to be the most centrist plan released by any major candidate — and as such it is going to set a marker on one half of the debate within the party. It’s also the kind of place you could see a Senate swing vote like Joe Manchin ending up, so depending on how many votes we have in the Senate in 2020 this might be the best plan that can get 50 votes.
So let’s go through the details.
1) Public option. This is the centerpiece. A Medicare-like program with a buy-in, available to anyone, with standard ACA subsidies. One seemingly positive feature is that people who live in states that refused to expand Medicaid and would have been eligible get to “buy in” for free.
It differs from other Medicare-option Democratic plans such as Medicare For America (Schakowsky-De Lauro), or Buttigieg’s Medicare-for-all-who-want-it, mainly by being much, much less aggressive about auto-enrollment. And of course it’s nothing like the Sanders/Warren Medicare for All plan. Whether this is a feature or a bug depends on who you’re talking to!
2) Beefed-up subsidies. The premium cap is lowered from almost 10% of income to 8.5% of income, and the subsidies are now linked to Gold rather than Silver plans. Charles Gaba (Brainwrap) would be more easily able to comment on this, but the net result seems to be a significant decrease in cost for most people.
3) Drug price reforms. These seem fairly standard consensus Democratic plans in the sense that they’d likely get a unanimous vote from our House caucus and probably the Senate one too. Allow Medicare to negotiate. Allow re-importation of some drugs. One interesting one is that it seems companies that jack up drug prices would face tax penalties.
4) Pay-for: tax hikes on the rich. The pay-for is clearly laid out. Top bracket goes back to 39.6%. But that’s not the big one here — he’s also proposing to make the capital gains tax progressive and put the top bracket there at 39.6% too, up from the current 20%. That’s a really important step. The rates might not be as high as in the plans of some of his primary rivals, but it’s nice to see capital gains income being treated the same as regular income.
Overall thoughts: I’d prefer to be a little more aggressive. I really like the Schakowsky-De Lauro plan — the auto-enrollment is better, and it also really thinks hard about how to move away from the employer-provided-health-insurance model. Biden’s plan does not envision as many fundamental or structural changes, which I think is a failure of imagination. That said it’s a decent start, a dramatic improvement over the current system, would make a lot of people’s lives meaningfully better, and if in place could be a launch pad for further progress down the line. Which... sums up Biden’s candidacy pretty well, come to think of it.