(Bloomberg Opinion) -- Health care has emerged as a key issue in the 2020 presidential race, and an area where Democrats believe they can gain an advantage with voters. When it comes to policy, though, most of the Democratic field is big on vision, and a bit lighter on particulars. Only a few, like Senator Bernie Sanders and former Congressman Beto O’Rourke, have endorsed specific legislation; most others have endorsed the general idea of universal health care. So it’s a big deal that front runner Joe Biden posted a plan Monday that at least begins to flesh out the details of his preferred approach.
Biden, the former vice president, argues that Democrats should start by building on Obamacare, and that “Medicare for All” supporters would erase the law’s achievements. It makes sense that he’s attached to the legislation; it was one of his most significant career accomplishments. But even Biden, the leading moderate in the race, has ideas that move beyond the most ambitious early versions of the law.
The plan Biden unveiled is an outline, and there are still questions left unanswered. It shows promise, though. The most conventional part of Biden’s plan would increase the generosity and availability of subsidies for Obamacare plans, and would also cap premiums. These moves could boost affordability and enrollment.
The more exciting aspects center on his ideas for a government-run public plan that would compete with private insurance. Plenty of others have proposed or support similar approaches. Biden's stands out by offering premium-free coverage via that option to low-income Americans in states that have rejected Obamacare’s Medicaid expansion, helping a vulnerable population. It would also be available to all Americans, including those that have access to employer insurance.
Employer insurance is the gold-standard for coverage, but it can be quite costly for many. Depending on how affordable and attractive the public plan is is, many Americans could end up ditching what they’re offered at work.
Biden’s plan is a good start in some ways, but there are still areas that haven’t been fleshed out. His next choices will determine whether he is offering a genuinely ambitious moderate option or an incremental tweak that leaves him open to criticism.
We don’t, for instance, have enough detail about Biden’s public option to know who would switch or how much it will change the health-care system yet. His outline describes it as "like Medicare," but doesn't detail what patients might have to pay out of pocket for care or what benefits would be covered. It’s not entirely clear whether lower-income workers who have access to employer plans will be eligible for subsidies. The status of millions of potential enrollees and billions in spending could hang on that one important question. Cost controls beyond prescription drugs and payment rates for providers, the third rail of health-policy, aren’t extensively discussed either.
It’s worth considering bold solutions. A more expansive public option would help more people, though it may endanger Biden’s claim that his plan will cost $750 billion over ten years. It will also be easier to defend against inevitable criticism from single-payer advocates on how his proposal preserves too much of the costly, unequal, and inefficient status quo. Those critiques could easily overshadow the potential positives of his plan. It’s more likely to pass Congress than Medicare for All and could help people faster because it builds on existing infrastructure.
It’s possible to be too safe, and as he fills in the gaps, Biden should make sure his proposal retains enough edge to stand out.
To contact the editor responsible for this story: Beth Williams at bewilliams@bloomberg.net
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care. He previously wrote about management and corporate strategy for Quartz and Business Insider.
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