Since the beginning of the primaries, both Elizabeth Warren and Bernie Sanders have been grilled, endlessly, about their health care plans and how they plan to implement them and exactly how much they will cost and how they probably terrify all of the voters who love their health insurance companies so very much. As much as I would give my right arm for someone to ask one of the anti-Medicare-For-All candidates how they intend to pay for their plans or how they expect those plans to cost less than what we are paying now if they don't have any of the cost-saving benefits of Medicare For All, that's not going to happen.

And it doesn't totally matter. Asking them about this is like asking me about my plans for all the stuff I bought at Michael's when I decided I was gonna get into macrame for a hot minute. You know and I know I'm never going to actually get around to it, but we can all pretend that at some point I am going to make a lovely wall hanging of some kind.

All the other candidates have to say, in order to not be questioned any further, is that health insurance companies are amazing and benevolent entities that everyone loves, that their plans will only cover the people who "want" to be covered, and hint to rich people that they will not have to use the same health insurance as all the grubby poors. Like my macrame plans, no one needs to actually know the logistics.

However. Pete Buttigieg's "plan" is legitimately insane.

While two debates have passed since he released his plan, now that he's "surging" and appears to have an actual shot at becoming President of the United States, it's time to take it a little more seriously. As best as we can.

As you've probably heard, Buttigieg calls his plan the "Medicare For All Who Want It" plan. It's some very clever marketing on his part, combining the street cred of actual Medicare For All plans with a gentle nod to the insurance industry's favorite talking point, "choice." Which, by the way, actual ex-insurance executives will tell you is absolute bullshit.

The way it will work, supposedly, is that people will have a "choice" to enroll in a public option where they pay the government for their health insurance, or to keep their beloved private health insurance (though they have no actual plan for how people are going to be paying for/buying into this public option yet). Now, that seems normal, right? That's like, the general moderate plan that they all have.

But the thing with Buttigieg's plan is that those who don't officially enroll in the plan but do not have private insurance will be retroactively enrolled at the end of the year anyway, and then surprised with a giant bill for all of the health insurance they did not use. And this bill could be up to 8.5 percent of their income for that year.

Via The Washington Post:

Buttigieg's campaign has not identified how it envisions charging Americans who do not make their premium payments, but the campaign has said that all premiums would be capped at 8.5 percent of income. It is unclear how many people could be affected by retroactive enrollment under Buttigieg's plan, and the campaign did not provide an estimate. The Buttigieg campaign said "one option" for those who do not pay their health premiums is to charge these people through their yearly tax filings. The campaign also said low-income people would qualify for federal subsidies to reduce the cost of their health-care payments.

Before its repeal, the Obamacare mandate hit people without insurance with a $695 annual fine or a charge worth 2.5 percent of their income, depending on which was higher. Critics say Buttigieg's plan could leave people with year-end bills of more than $7,000.

One would have to assume that most people who would not sign up for this public option and simultaneously don't have employer-based health insurance or private insurance would also not have $7,000 in savings at the ready to spend on Medicare For All Who Didn't Want It But Then Got It Automatically Although They Didn't Use It, Surprise! That could decimate someone. Hell, it would decimate me. What would happen to people who couldn't afford to pay?

Mayor Pete has been talking a lot about how it's unfair that people won't call his ideas "bold" just because they are "pragmatic," repeatedly assuring us all that one can be simultaneously "bold" and "pragmatic." I don't know if either of those words is quite right for this, though.

I mean, I guess it's "bold" to assume that people will not flip the fuck out if they get a surprise bill for $7,000 for health care they have not used, but not necessarily in a good way. If moderates think people are going to flip over an employer-side payroll tax of no more than 7.5%, depending on how big a company it is (Sanders) or an employer contribution of 98 percent of what they are currently paying for private health insurance (Warren), what do they think people will do if they all of a sudden get that kind of crazy-ass tax bill?

Another bummer here is that the healthcare people on the public option would get is also not going to be that good. That's not me being snide, it functionally can't be. The whole point of doing things this convoluted way is to ensure that for-profit has insurance has a role, and that there are not long wait times for those who can afford to buy it. If it covered everything and all doctors and hospitals had to take it, what sense would that even make?

The rationalization for the retroactive billing is that the penalty is necessary so that people don't just go and sign up when they suddenly get sick, rather than paying into it all along, because that would obviously bankrupt a public option model. It's the same reason why the Obama Administration had to institute the $695 penalty. It also ensures that there will be money to pay health care providers for taking care of these people in the event of an emergency.

Simpler is almost always better, especially when it comes to things like this. The more confusing and convoluted things get, the more surprises there are, the more paperwork there is, the more means-testing and tiers, the more people are gonna get wigged out. That's actually a big reason why I like single-payer Medicare For All. It's simple. It requires no extra work for people. It's just there, they have it, and they never have to think about it, ever. There are no "penalties" (especially against poor people) necessary to make it work, because it just covers everyone automatically.

As far as PeteCare goes, I get it. It's not going to happen anyway, so why not try to put forward a plan that will, ideally, be a bulwark against criticism from the health care is a human right crowd without scaring the bejesus out of insurance companies? From a purely strategic perspective, it doesn't have to be perfect or even workable so long as it accomplishes those things. But the fact that he looked at this and thought "Boy, this is great and not at all completely batshit!" does give me pause.

[Washington Post]

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