opinion | How come we never talk about Joe Biden’s health plan?

Much of the “60 Minutes” interview is taken up by a stirring exchange about the president’s imaginary “health care plan.” Stahl keeps asking Trump how he would protect people with pre-existing conditions, he says, “They will be protected,” she keeps asking how, and he keeps saying he’ll protect them.

Similarly, Stahl asks Trump when we will see this phantom plan, he insists the plan already exists, and they go back and forth.

This will not be the last time we repeat this ritual. And it’s tempting, when the President keeps telling this absurd lie — and when his administration is asking the Supreme Court to scrap the Affordable Care Act in its entirety, which would wipe out those protections and much more — to keep doing so.

But here’s something we haven’t done that we could do instead: talk about Joe Biden’s health plan.

Because unlike Trump, that’s how it is an actual plan. You can read it here. It has many provisions, both general and specific. Should Biden become president, he will introduce a version of it that will then be debated and debated in Congress; it is negotiated and fought and modified and voted on. It could even become law.

But while there was an extensive health debate during the Democratic primary, that discussion has almost entirely disappeared. The closest we seem to come to is when Republicans accuse Biden of secretly supporting single-payer health insurance, and he says no, he doesn’t support that.

So most voters probably don’t know much more than the fact that Biden likes the ACA and Trump hates him, and if Biden becomes president he will do anything to strengthen the ACA. Which is not entirely wrong, but omits a lot.

Because while Biden’s health plan isn’t a payer, it’s still incredibly ambitious. In fact, it goes far beyond what President Barack Obama thought was politically feasible during the ACA debate. If enacted in its current form, it would dramatically increase the number of Americans who have secure government coverage.

Let’s recall some of its main provisions:

  • Create a public option, a Medicare-like plan open to anyone who wants to join, including those currently insured through employers.
  • Automatically and free of charge enroll low-income people in Republican states who refused to accept the ACA’s expansion of Medicaid.
  • Substantially increase ACA subsidies for those who earn too much to qualify for Medicaid but still struggle to afford private insurance.
  • Allow Medicare to negotiate drug prices, which the law doesn’t allow; This is one of a number of provisions, including allowing medicines to be re-imported, aimed at reducing prices.
  • Lower the age of Medicare eligibility from 65 to 60.
  • Repeal the Hyde Amendment and take other steps to secure and expand reproductive rights.

There are many other ideas in it – promoting community health centers, stopping “surprise bills”, trying to reduce maternal mortality – but these are the big ones.

If and when Biden goes ahead with this plan, it will be a enormously a legislative battle perhaps as big as the passage of the ACA itself that engulfed Washington for the better part of a year. Healthcare interests – insurers, hospital chains, pharmaceutical companies – will spend hundreds of millions or even billions of dollars to fight back. Republicans are going to go absolutely insane and invent all sorts of lies to discredit them. Do you remember “death tablets”?

While there are many issues a Biden administration and Democratic Congress would face, this might be the most contentious. And if they succeed, it would be hugely important, as they would provide more health coverage to tens of millions of Americans and provide real competition for private insurance.

But we hardly talked about it. As if Biden had won the primary and Medicare-for-all was off the table, we all decided that the only health discussion left was to hammer it into people that Trump and the Republicans are lying when they say they want it to protect people with pre-existing conditions.

Which they are, of course, and it’s important — if the Republican lawsuit succeeds when it’s heard by the new conservative supermajority on the Supreme Court in November, it will be an absolute disaster for the country’s healthcare system.

I doubt that will happen. Not because the court’s conservatives don’t want to take down the ACA, but because at least some of them are smart enough to realize that doing so would be a political disaster for the GOP and makes it much more likely that the Democrats will expand the court.

Still, Biden himself and other Democrats currently have far more incentive to talk about the threat of the court nullifying the ACA than about his plan — the threat will excite and motivate voters. But let’s not forget that if he wins, we have another important fight ahead of us.

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