August 2, 2024
Dear Interested Readers,
What Would Kamala Harris Do For Healthcare If Elected?
For almost two weeks now newspapers, podcasts, and television commentators have been busy trying to present Kamala Harris to many potential voters, especially independents in swing states who don’t know her or what her positions might be although she has been the Vice President for three and a half years. In a move reminiscent of his claims that Barack Obama wasn’t born an American citizen, Trump being Trump, earlier this week attacked Harris’s racial identity. He told the convention of the National Association of Black Journalists that until recently he had always thought she was Indian. Trump implied that the vice president now claimed to be Black because it was politically expedient. I assume that he must have known no one in the audience was fooled by him, but he knew that he would get publicity and there would be voters who would believe him or appreciate his feistiness in front of a hostile audience. At the same event, Trump claimed once again that he had done more for Black Americans than any president since Abraham Lincoln. I guess that would include FDR, JFK, LBJ, and Barack Obama.
Trump’s inflated ego and his willingness to try to prevaricate his way back into power never cease to amaze me. The only thing that amazes me more is that almost fifty percent of the electorate either approve of his tactics or believe him and are willing to vote for a man with such obvious intellectual and character flaws. What does his success say about us?
Another line I have heard frequently this week is speculation about how long the overflowing enthusiasm for the candidacy of Harris will last. In a New York Times article entitled “Harris Created a Huge Wave of Energy. How Long Can Democrats Ride It?” written by Lisa Lerer, Maya King and Reid J. Epstein, we read:
Ms. Harris’s ascent to the top of the ticket has transformed the presidential race into a fundamentally different contest, delivering an electric shock to a listless Democratic Party that for more than a year struggled to mobilize its base behind Mr. Biden.
But the real test awaits: whether Ms. Harris can convert the wave of pent-up liberal energy into sustained momentum. While polling shows that the party’s core voters have rallied behind Ms. Harris, the race remains in a dead heat, reflecting the politics of a fiercely divided nation. After months of Democratic attrition over a weakened candidate, Ms. Harris must now rebuild the coalition that powered Democrats — and the Biden-Harris ticket — to victory in 2020.
Some pundits have moved to speculating how Vice President Harris will distinguish herself from President Biden. She has been a key part of his administration, and any disagreements in policy preferences have been behind closed doors. As they face the public, there is no daylight between the president and the vice president, but during the Democratic Presidential Primary campaign in 2020 and her tenure in the Senate, Vice President Harris espoused positions that were “left” of Biden. One domain where there were significant differences in their positions was healthcare.
Like me, you may wonder what healthcare policies Vice President Kamala Harris will propose as the campaign progresses. There may be no debates. So there may be no time when she or Trump will be asked about their healthcare position and we can judge their differences. Maybe she should avoid talking about healthcare or taking any policy positions. Currently, she is gaining ground just by talking about a better future and accusing Trump of only talking about the past and himself. Vice President Harris’ best strategy may be to “prosecute the case” against Trump. In the transcript of an NPR report by Deepa Shivaram entitled “​​Harris is leaning into her history as a prosecutor. It’s not the first time.” we read:
Two days before President Biden announced he would step back from his push for a second term, his campaign chair Jen O’Malley Dillon appeared on television, insisting the president would stay in the race.
“He is the best person to take on Donald Trump and prosecute that case,” Dillon said.
But about 72 hours later, it was instead Vice President Harris making that same argument — and reviving a case she had made in 2019, when she ran in a crowded Democratic field seeking the nomination that year.
“Before I was elected as vice president, before I was elected as United States senator, I was the elected attorney general, as I’ve mentioned, of California. And before that, I was a courtroom prosecutor,” Harris said to campaign staffers in Wilmington, Del., on the day after Biden endorsed her to take his place at the top of the Democratic ticket.
“In those roles, I took on perpetrators of all kinds — predators who abused women, fraudsters who ripped off consumers, cheaters who broke the rules for their own gain. So, hear me when I say: I know Donald Trump’s type,” Harris said, in a line that has become the centerpiece of her whirlwind campaign.
So, if it is wise to keep things simple and focused on why Donald Trump should never get to the White House again, it is okay with me if we don’t hear much about healthcare during the next 94 days, but I have found a few articles on the Internet that attempt to predict her healthcare positions and the policies she will support by recounting her positions in 2019 during the early debates of the 2020 Democratic Presidential Primaries. Using those statements as a starting point they then speculate on how or whether her opinion has changed over the intervening years. A good example is an article published online this week by Forbes magazine and written by Avik Roy. Near the end of the article which is entitled “If You Like Your Health Care Plan, Will Kamala Harris Let You Keep It?” we read:
…health care remains one of the most important policy issues in America. Rising health care costs are arguably the single greatest threat to Americans’ living standards, and health care spending is the biggest driver of growth in the federal debt, outside of interest payments. Harris will no doubt be asked about her health reform views, and the country would be well served to know her answer.
In another Forbes article written by Joshua Cohen and entitled “Harris Builds On And Differs From Biden Administration’s Healthcare Policies” we read:
If elected President, presumptive Democratic nominee Kamala Harris looks to expand upon the Administration’s efforts to reduce healthcare costs. But Harris will also likely distinguish herself from President Biden in a number of areas, including more vocal support for abortion rights and a possible broadening of the scope of the role of the federal government in the healthcare sector.
On the issue of abortion, Vice President Harris has been a much more outspoken advocate than Biden. Harris has forcefully called on Congress to restore the protections offered by Roe v. Wade with respect to women’s reproductive rights. She has made women’s autonomy in deciding whether or not to end pregnancies a centerpiece of her campaign…
There is no question that since the last presidential election in 2020 and the overturn of Roe v. Wade in 2022, abortion has displaced the cost of care and universal access to care as the medical issue of the highest priority for Democrats. Abortion may be the issue most likely to appeal to independent voters in swing states. Vice President Harris has been a much more effective challenger of the Dobbs decision than President Biden. Her efforts to support the personal right of women to make decisions about their reproductive rights were central to the Democratic efforts in the 2022 midterms to abort the disaster of a Republican Red Wave which might have given Republicans control of both houses of Congress.Â
In my mind, abortion is a human rights issue as much as it is a medical care issue, but then again I also believe that access to adequate healthcare is also an issue of human rights and equality. Dr. Martin Luther King, Jr. was absolutely correct when he said:
Of all the forms of inequality, injustice in health is the most shocking and inhuman.”
Over the almost two weeks since President Biden announced his withdrawal from his campaign and endorsed Vice President Harris, there have been several articles and podcasts that have reminded us that in the past she had much more progressive views on universal coverage than she was obliged to advocate as part of the Biden administration. In 2017 she joined several other Democratic senators in support of Senator Bernie Sanders’s unsuccessful bill to establish “Medicare For All” which ironically would have abolished Medicare as we know it. For some time Senator Sanders has advocated that Medicare be abolished along with Medicaid and its state-to-state variation in access to care and benefits for the poor. Sanders’s plan would have also virtually eliminated private medical insurance. Had it been successful the Sanders bill would have provided equal care for every person in the country including non-citizens. Harris’s position may have changed over the intervening four years. Cohen jumps off from that reality and writes:
On the campaign trail, Harris has spoken of the need to expand Medicare—the government health insurance program for seniors and the disabled—to cover dental, vision and hearing benefits. She also trumpets the Biden Administration’s record on reducing levels of uninsured to their lowest in history and decreasing Medicare beneficiary out-of-pocket costs for prescription medications through provisions included in the Inflation Reduction Act…Moreover, beginning next year Medicare beneficiaries will have a $2,000 annual cap on out-of-pocket costs for outpatient prescription drugs.
Echoing Biden, Harris has expressed the desire to expand Medicare drug cost measures enacted by way of the IRA [Inflation Reduction Act] to the commercial sector where the majority of working Americans purchase their insurance.
But as [a] newly elected Senator in 2017, Harris was to the left of Biden on the issue of how to achieve universal access to healthcare. At the time, she called for a transition to a single-payer system, something Biden did not endorse.
Time will tell whether in 2024 she will realign with Sanders or continue the less disruptive approach advocated by President Biden. Cohen continues:
Since becoming Vice President, Harris has pivoted to seeking to improve the implementation of existing laws, such as the Affordable Care Act, to work towards universal access rather than a wholesale change of the system. Seen in this light, it’s probable Harris would want to extend the enhanced subsidies for people purchasing coverage in the Affordable Care Act exchanges. These subsidies can substantially diminish the cost of monthly premiums.,, And in line with the current Administration, Harris would want to work with Congress and state authorities to try to extend Medicaid coverage in the 10 states that haven’t yet expanded it under the ACA.
Cohen points out that a lot has changed since 2020. Universal access and the total cost of care seem to have morphed into discussions about controlling the cost of medicines and reducing medical debt. Cohen continues:
A separate initiative that Vice President Harris has focused on during her time in office pertains to medical bills and debt. According to a study by Commonwealth Fund, 79 million Americans have “medical bill or debt problems.” With respect to combating medical debt, Harris supports efforts to use funds from the American Rescue Plan to purchase medical debt from healthcare providers—an initiative that could lead to three million Americans having a total of $7 billion forgiven by 2026. Harris also seeks to prohibit medical bills from being included on individuals’ credit reports. Medical debt relief has come up during campaign rallies and may be featured more prominently as a “bread-and-butter” policy matter in the weeks and months ahead, Associated Press reports.
At the end of his article, Cohen makes a pronouncement. He seems to suggest that her position going forward will be more of an extension of Biden’s position than a reversion to advocating for Bernie Sanders’s Medicare For All.Â
Most of Harris’s public pronouncements regarding healthcare policy suggest she would continue on the path forged by the Biden Administration. Yet subtle differences in emphasis appear to be emerging as the Harris presidential campaign gets into full swing.
Last week I referenced an article from The Hill by Nathaniel Weixel entitled “Where Kamala Harris stands on health care issues.” I liked Weixel’s approach to the question of where the Vice President will stand on healthcare issues. He begins with the obvious number one issue, abortion, about which enough has been said for the moment.Â
Weixel moves from abortion to ObamaCare. He reviews her history of advocating for a slow movement toward Medicare For All, and then concludes:
…experts agree she is a staunch supporter of expanding ObamaCare and making health care more affordable for millions of Americans — something that is likely to be one of the biggest health care fights in Congress in 2025. Â
The last two sections of Weixel’s article are on drug prices and the cost of healthcare. He is obviously a “splitter” and not a “lumper” since the cost of drugs is definitely a major part of the overall cost of care, but his splitting did give me a new term to add to my healthcare cost vocabulary. Weixel says that Harris advocates “march-in rights.” For those who, like me, have not heard of “march-in rights” it refers to the opportunity of the government to “seize patents of high-priced: drugs developed using federal research to make them more affordable and increase competition.” I have believed for years that taxpayers pay for a lot of the research that drug manufacturers use to develop effective meds and then charge those same taxpayers as if they had produced the drug using only the cash of investors.Â
On the cost of care, Weixel writes:
As the attorney general of California, Harris focused on health care consolidation and clashed with major insurers, hospitals, and drug companies. Her record indicates she isn’t afraid to aggressively use antitrust laws to keep companies from raising costs due to anti-competitive behavior. Â
Near the end of his piece, Weixel presents recent positions and actions about to lower the cost of care that she has taken that are encouraging as we think about how the Vice President will approach healthcare costs if she becomes president.
As vice president, Harris has taken the lead on the administration’s medical debt initiatives. Earlier this year, she announced a new set of rules that bans medical debt from credit reports.Â
“No one should be denied access to economic opportunity simply because they experienced a medical emergency,” Harris said at the time. Â
Other federal efforts to curb medical debt include the No Surprises Act, which took effect in July 2022 and prohibits surprise billing for most emergency services and non-emergency services done out-of-network.Â
We have evidence from the past of the Vice President’s genuine concerns about the cost, the quality, and the equity of healthcare for all Americans. Donald Trump had four years during which he did very little of substance to improve care. Like the shyster he has been shown to be in civil and criminal litigation, Trump tried to undermine the ACA and replace it with commercial offerings of dubious value that may have been good for corporations but would have undermined the efforts to move toward better care for everyone. John McCain’s downturned thumb saved us from that disaster. McCain is gone. Harris has shown that she will work for better healthcare for every American. I hope that the enthusiasm for her that we see emerging will only grow between now and November 5. I can hardly wait to see what she could do if elected along with Democratic control of Congress. Â
Summertime On/In The Water
The header for today’s letter shows a picture of my new sails which were delivered to me much too late. The sailmaker promised that I would have the sails before the end of June if I let him use the yellow fabric he had in stock. We had a houseful of family for the weekend of the Fourth of July and I had hoped we would enjoy sailing. The sails were delivered on July 11. My son and grandsons from California were still here for one more day and the weather on their last day was perfect for a sail with young boys. There was just enough breeze for a great sailing experience for the two boys ages almost 7 and almost 10. In the end, one day was better than nothing. The boys will be back next summer. We filled most of the good weather days for this trip with fishing.Â
My sailboat needed new sails because it was produced in 1972, and the sails on it were the original sails. I bought the boat over twenty years ago. Over the time I have owned this neat little boat, its sails had become ragged and were covered with patches. In today’s market a new “suit of sails” would cost more than I had paid for the boat. Sail “tape” is cheap so before this year, each sailing season began with applying more tape to the latest rips. I also use “iron-on” patches to extend the life of my favorite and most comfortable pants. I learned a warped form of frugality that has plagued me all my life from my father, a child of the depression, who would “squeeze a dollar till the eagle screamed.”
When I bought my boat I did not realize that there was a story behind it. It is an O’Day Javelin. The boat was designed by Uffa Fox a well-known boat designer from the Isle of Wright. About 5100 Javelins were produced by the O’Day Corporation of Fall River, Massachusetts which was founded by George O’Day in 1958. O’Day was a famous sailor, who died of cancer in 1987. O’ Day is in the sailing “Hall of Fame.” He won many famous races including the Gold Medal for 5.5-meter sailboats at the 1960 Rome Olympics. His boatyard built a variety of small “daysailers” that usually, like my Javelin, had retractable keels so that they were imminently “trailerable.” The Javelin was a popular racing boat. The smallest O’Day boat was a 12-foot “sailing dinghy” called the “Widgeon.”  When I bought my boat plus a 3-horsepower Johnson motor, circa 1990 and running well, for about $1000, I knew nothing of the boat’s history.Â
I am not a good sailer, but I enjoy the adventure when the breeze is not too stiff. My first experience as a sailer was on a “bareboat charter” in the Virgin Islands in the late seventies with friends who had sailed all over the world. I have been a “wannabe” sailer ever since. I know the principles, but being a good sailor is like being a good guitar player–it takes practice. I do best when sailing with someone who is better than I am, but the Javelin is a very stable boat. It is wide and has a retractable metal keel, so it is very stable in the water, and I can sail it by myself, but I feel much more comfortable when sailing alone in my old Sunfish, which, ironically, is also circa 1972 and has its original sail.
When I am not “on the water” I am in the water. I enjoy a daily open-water swim of about a quarter mile. As the summer has progressed, I have shed my wetsuit. My stroke is stronger and my endurance has increased. The water is still a little chilly when you first enter it, but on the hot humid days of global warming, the cool water is refreshing. For safety’s sake, because I am swimming alone, I usually swim back and forth between two buoys that are about 75 yards apart. The water on my route is never more than five or six feet deep so it’s almost like swimming in a pool, but there is no chlorine. The chlorine in pools takes my “hide” off.Â
I am planning to do more sailing this weekend if the conditions meet my narrow window of expertise which means just enough wind to keep me moving, but not so much that my marginal skills are challenged. If you are ever passing by New London and want to go for a sail, please stop in to see me! If you are not available for a sail this weekend with me, I hope that whatever you have planned for the weekend will “exceed your expectations!”
Be well,
Gene
