Biden’s campaign says one of the Biden comments Sanders is objecting to, about Sanders’ plan supposedly causing “hiatuses” that would hurt sick people, has been misinterpreted. Regardless of what Biden intended to say, though, his “hiatuses” remark allowed Americans to come away with the inaccurate impression that Sanders’ plan would cause people to temporarily lose insurance coverage.
Facts First: A single-payer Medicare for All plan would not result in people having a “hiatus,” or gap, in their insurance coverage, experts say.
Speaking at a forum hosted by AARP in Iowa on Monday, Biden criticized Sanders’ proposal to abolish most private insurance and have every American moved, in a multi-stage process over four years, onto a generous insurance plan provided by the government through an expanded version of Medicare. Calling such single-payer plans “a little risky,” Biden raised the subject of people dying of diseases like cancer, then warned of “hiatuses.”
The debate is over what Biden meant by “hiatuses,” since he did not finish his sentence and was not specific. Here is what he said.
“And all of you: how many of you have lost a husband, wife, son, daughter to cancer, raise your hand. How many (inaudible) have terminal diseases, raise your hand, that lost them? Well, you know, the thing I’ve learned is: Every second counts. It’s not about a year, it’s about the day, the week, the month, the next six months. It’s about hope. And if you have these hiatuses, it may, it may — this may go as smooth — as my grandpappy said — smooth as silk. But the truth of the matter is, it’s likely to be a bumpy ride getting to where we’re going. Even the people who have disagreed with my plan say, ‘Well, we’re going to have to transition three, four, five years to get there.'”
To Sanders, and to us, it sounded like Biden was suggesting that Sanders’ plan would result in sick people having a gap in their insurance coverage during the transition to single-payer.
We contacted four experts in health policy. All four said that the transition to single-payer would not result in people facing such breaks in their coverage — though they also made clear they could not be certain about what Biden meant.
Jonathan Oberlander, a health policy professor at the University of North Carolina at Chapel Hill, said that while there are many legitimate criticisms of Medicare for All, Biden’s claim is not one of them. “There is a transition period, but that is not the same as a hiatus, which implies people would temporarily lose insurance protections,” Oberlander said.
Joseph Antos, a health care scholar at the conservative American Enterprise Institute, said the transition to single-payer would likely cause significant “confusion” among average consumers, the health care sector and employers, especially considering that the transition to the much-less-ambitious Obamacare itself caused confusion. But Antos also said, “‘Hiatus’ sounds like that people would be without coverage, and I think they wouldn’t be without coverage.”
Gerald Kominski, a health policy professor at the University of California, Los Angeles, said Biden was employing a “classic scare tactic that politicians use, particularly with the Medicare program. If you tell Medicare recipients that they might lose their coverage ‘for a while’ during the transition to a Medicare for All program, they are obviously going to be skeptical of Medicare for All.”
But that is not what Biden was actually telling people, campaign spokesman Andrew Bates said.
Bates said Biden was not claiming that Sanders’ plan would result in anyone having a hiatus in their coverage.
What Biden was saying, Bates said, was that Sanders’ plan for a sweeping overhaul of the health care system would take much longer than Biden’s own plan to be approved by Congress — so, under Sanders, there would be a hiatus between the status quo and the possible future arrival of an improved system.
The campaign noted that Biden made that point more directly in comments on Friday, before the AARP event.
“I don’t want to start over. Because look, you know, how many of you out there have had someone you’ve lost to cancer? Or cancer yourself? No time, man. We cannot have a hiatus of six months, a year, two, three to get something done. People desperately need help now,” Biden said Friday.
We agree that this version of the comment was clearer. But that doesn’t change what he said at the AARP forum, which was ambiguous.
After Biden’s campaign offered its explanation about his AARP remarks, we re-contacted the experts we had previously spoken to and told them what the campaign was arguing. Kominski said he still thought Biden’s comment had been misleading. Oberlander said he thought the campaign’s explanation could be plausible, but still believed Biden’s comment was, “at the very least, a confusing use of the term ‘hiatus’ in a way that could mislead listeners.”
Finally, it’s worth noting that Biden would also be likely to face major hurdles in getting his own health plan through Congress. (He is proposing a new “public option” to allow people to buy into a Medicare-like government plan if they want, plus a significant increase in Obamacare subsidies.) So if the “hiatus” is a gap between the current situation and the day an improved system comes into place, Biden’s plan has a hiatus problem, too.