The reality is that Biden has demonstrated little to no interest in responsible fiscal stewardship of America's health care programs. He boosted Obamacare subsidies in the ARP without either raising revenue or cutting spending. He has been so focused on boosting enrollment that he has encouraged fraud. He has allowed health care spending to continue its long march over the federal budget, overtaking nearly everything else, adding trillions to the long-term debt, and in the process contributing to rapidly rising cost of interest payments. In the meantime, he has pursued small bureaucratic tweaks that make it harder and harder for Americans to escape Obamacare's imposing regulatory costs.

There is no reason to think that Harris would depart significantly from this approach. As she began campaigning for president, she signaled that her economic policies would prioritize expanding federal funding for health care and social programs. In her first major speech on economic policy, Harris promised to "take on the issue of the cost of health care," and attacked Trump for wanting to repeal Obamacare, and for having no plan to expand health care access. A headline in The Hill summarized her health care agenda: "Harris vows Biden-era health care programs will get bigger."