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Photo: Senate Democrats

Over the weekend, Elizabeth Warren released her plan for transitioning to Medicare for All. It's a not-inconsiderable prospect, since America doesn't so much have a healthcare "system" now as it has a messy, incomplete patchwork of public and private providers and payment systems that leaves tens of millions of us with inadequate care, or no healthcare at all. (GoFundMe is not a healthcare system.) Warren's proposal lays out a two-stage roadmap for getting to single-payer: Phase in a very strong "public option" (including government-paid coverage for all children and low-income folks) first, then as people realize there aren't any death panels and Republicans are still lying to them, switch over to a true single-payer healthcare system like other industrialized countries have.

As Dylan Scott notes at Vox, the plan makes a "tacit concession" to where primary voters seem to be at the moment: They like the idea of single-payer, but they're also scared of remaking healthcare all at once. Fine, this plan says: Dip a toe in, and you'll see this works. The plan she suggests has M4A as the goal, but this transition allows her to put forward a package she can "argue is more likely to actually pass 18 months from now." Let's take a nice Policy Dive!


When Warren talks about a public option as a bridge to full M4A, she makes very clear she's not presenting it as an alternative that would preserve a big private-insurance system as the norm, with some socialist healthcare squeezed in at the edges. Even her "public option" is far more robust than the proposals out from Kamala Harris and Pete Buttigieg, since it would bring genuine no-copay, no-deductible comprehensive healthcare to tens of millions of Americans toot sweet.

Assuming a Democratic Senate majority, Warren would pursue phase one through the budget reconciliation process, so even if the filibuster is still with us (she wants it gone, ultimately). a simple majority of Dems in the Senate could pass it.

I won't hand Mitch McConnell a veto over my health care agenda. Instead, I'll give every American over the age of 50 the choice to enter an improved Medicare program, and I'll give every person in America the choice to get coverage through a true Medicare for All option. Coverage under the new Medicare for All option will be immediately free for children under the age of 18 and for families making at or below 200% of the federal poverty level (about $51,000 for a family of four). For all others, the cost will be modest, and eventually, coverage under this plan will be free for everyone. [Underline in original]

In addition, Warren would use executive powers in her first 100 days to enact a number of reforms that would bring down medical costs, particularly for prescription medications. We won't go into the details of the federal powers she'd invoke to get around price gouging and anti-competitive practices by pharma companies, though she certainly does; go see the plan. But since the federal government has the ability to do something about lifesaving drugs that cost too much, like insulin, EpiPens, or treatment to prevent transmission of HIV, then Warren says let's use the law to bring down drug prices wherever we can right away, and then make cost regulation a central part of the final M4A plan. Not only No More Martin Shkrelis, but no more people dying because they can't afford insulin.

In addition, Warren emphasizes that her lobbying reform plan and aggressive anti-trust action are central to getting to Medicare for All, because if Big MedPharma Money continues to drive the agenda -- including inflated prices for generics -- nothing's ever going to get fixed.

Warren would also prioritize reversing the Trump administration's multiple attempts to undermine the Affordable Care Act, undoing the rule changes and program cuts that haven't managed to kill Obamacare but have made it far more costly and harder to access. She'd also get rid of the junk insurance plans Trump has brought on the exchanges, which offer lower premiums but are often useless when someone actually needs medical care.

In addition, even as the new Public Option seeks to move millions from Medicaid to Medicare for All (and would provide healthcare to low income folks in red states that never expanded Medicaid), Warren would also roll back Trump efforts to gut Medicaid, like burdensome work requirements or the various states' evil efforts to toss kids off Medicaid/CHIP for what amounts to paperwork errors.

From beginning to end, and continuing once M4A is in place, the concerns of workers, public health experts, and patients would be represented in all the planning. But insurers and corporate interests wouldn't be allowed to set the agenda. They've had their turn, and it's been horrible.

In the second stage of the plan, to start no later than the third year of a Warren presidency, she'd work with Congress to finish the job and pass full Medicare for All, which she says people would be more ready to embrace once they see how well that public option is working. Why not just stop with a public option and call it good? In short, because having two systems, one public and one for-profit, is inefficient and unaffordable, and will allow insurance companies to continue to gouge people for a profit. Warren sees the possibility of private supplementary insurance to cover the few services not included in M4A (like concierge healthcare outfits or plastic surgery, maybe), but you won't really cover everyone at an affordable cost until patient care, not the profit motive, is the main focus of healthcare. And in a warning that seems particularly aimed at Pete Buttigieg and Joe Biden, Warren says the goal has to be full coverage for everyone:

Let's not kid ourselves: every Democratic plan for expanding public health care coverage is a challenge to these industries' bottom lines – and every one of these plans is already being drowned in money to make sure it never happens. Any candidate who believes more modest reforms will avoid the wrath of industry is not paying attention.

If they're going to call it socialized medicine anyway, then by golly let's have socialized medicine, the kind that works in Europe.

Warren's proposal is already taking fire from single-payer advocates who say any intermediate steps are less a "transition" than a cop-out, and that breaking the effort into two bills just increases the chance that Republicans will kill one or both. Warren argues, persuasively, we think, that a public option step will actually make full M4A more likely, as people see children, low-income folks, and purchasers of the public option getting good healthcare for less money and want in on that deal. And unlike some of the "centrist" plans, there's no mistaking that even an aggressive public option is only a step, not a goal in itself.

Again, we are summarizing a hell of a lot here; go look at the full plan, and of course keep in mind any healthcare proposal in the campaign is likely to look very different from what ultimately gets passed.

["My First Term Plan..." / Vox / NYT / Common Dreams]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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