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.”
But it is not true that a person facing such a diagnosis would “automatically” get Biden’s public option, because access to that public option will still be determined by a complicated system of premiums and subsidies—in other words, means testing.
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This was also clear in his much-noted spat with Castro. Castro mentioned his grandmother, who had Type 2 diabetes but also had access to Medicare, and noted that Biden’s plan would require people to opt in, without being automatically covered. Biden took great issue with the assertion that people would have to “buy in,” leading to the dramatic moment that grabbed everyone’s attention—Castro poking fun at Biden’s memory, asking if he already forgot what he said. Castro was right: Biden did say that people could “automatically” get his “Medicare for choice” plan. But Biden said “buy in,” not “opt in”—so how could people “buy” in automatically?
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When Sanders noted that the United States spends twice as much per capita on health care as other countries do, Biden replied: “This is America.” It would have been better if Sanders had finished his thought by noting that America spends twice as much as other countries
for worse health care outcomes, but no matter. This is the essence of Biden’s defense of the broad status quo: a patriotic bumper sticker, felt with such keenness it’s hardly surprising that he doesn’t seem to understand anything else about the issue.
What is usually a dark joke—We’re Number One (In Gun Deaths and Obesity)!—was trotted out as an earnest defense of America’s absurd health care spending. American health care spending is high because we’re America, baby: We’ve got those big-ass trucks, Doritos Locos Tacos, and a healthcare system chock full of profiteering and blood-sucking greed. If you don’t like it, leave—for a country with single-payer.