There was a brief period about a year ago when “Medicare-for-all” was on every Democrat’s lips, in what seemed to be a dramatic shift to the left within the party. If you paid close attention, however, it was clear that people were using the term in vague ways that didn’t necessarily mean they were committed to a single-payer system.
As candidates were forced to get specific, a split emerged between those such as Bernie Sanders who held fast to the single-payer goal, and others who decided that “Medicare-for-all” didn’t actually have to mean for all. It’s important to note that Sanders himself doesn’t really propose Medicare for all — in his plan, the government program would be much more comprehensive than Medicare is, wouldn’t include cost-sharing (which Medicare does) and would pretty much get rid of Medicare Advantage, the program by which private companies administer Medicare benefits.
That’s why, if you assume that Medicare-for-all means simply bringing everyone into Medicare as it exists today, the closest thing would be Kamala D. Harris’s plan, which allows for something like Medicare Advantage. So where does Buttigieg fit into this spectrum?
In its basic structure, Buttigieg’s plan is very similar to what Joe Biden proposed. But before you assume that makes it some kind of centrist sellout, remember that Biden’s plan is quite progressive, especially compared with the Affordable Care Act.
Like Biden and others, Buttigieg would create a public option that anyone could buy into. He’d auto-enroll people without insurance in order to eliminate the problem of the uninsured. He’d boost subsidies to make insurance more affordable. And he’d take some (vaguely described) steps to bring down the system’s overall costs. In other words, it would be a dramatic expansion of public insurance and regulation of the health-care industry.
But I want to home in on this portion of the explanation on Buttigieg’s website:
Through Pete’s Medicare for All Who Want It plan, everyone will be able to opt in to an affordable, comprehensive public alternative. This affordable public plan will incentivize private insurers to compete on price and bring down costs. If private insurers are not able to offer something dramatically better, this public plan will create a natural glide-path to Medicare for All.
This is an attempt to say to Medicare-for-all advocates, I’m on your side … basically. And even if it’s meant to be a bit of political needle-threading, it’s perfectly defensible. It’s one of the reasons that back in 2009 a public option was what liberals advocated, and why insurers and conservatives were so terrified of it: If government insurance is as good as liberals think it will be, more and more people will migrate toward it from their private coverage, and the insurance companies will wither away.
It’s also good politics, since a voluntary plan is much more popular, at least in polls taken up until now, than Medicare-for-all. The idea of not being forced into anything is extremely appealing, whether a public option is more effective as policy than single-payer or not.
So now we’re at a place where we have multiple plans but two basic approaches: Medicare-for-all, advocated in some form by Sanders, Harris and Elizabeth Warren, or a public option, advocated by pretty much everyone else.
Although there has been plenty of debate over health care, you can’t say that the Democratic electorate has really arrived at a consensus — and it may not do so. There are Medicare-for-all die-hards who view any compromise on the issue as a betrayal. But there may also be a lot of Democratic voters — maybe even a majority of them — who like the sound of Medicare-for-all but also would be okay with a public-option approach like Biden’s or Buttigieg’s.
And that brings me to the wild card: Warren. As I’ve noted, the fact that Warren hasn’t released a health-care plan yet is bizarre, since she’s released plans on pretty much everything else, from child care to corporate board restructuring to keeping leaves out of your gutters.
Warren says she supports Medicare-for-all and frequently criticizes insurance companies, but I can’t help but suspect that the delay in her producing a written plan has something to do with those polls showing voluntary public options to be more popular. I’m not sure there’s a way for her to offer something that sounds more voluntary while staying true to her prior statements about Medicare-for-all, even if it’s what primary voters might want.
But if most Democratic voters find multiple options acceptable to them, it may not matter as much. And we can be fairly sure that whether the Democratic nominee is someone advocating Medicare-for-all or Medicare-for-all-who-want-it, Republicans will make pretty much the same argument: This is socialism, they want to take away the insurance you love, they’re going to raise your taxes, it will turn America into such a hellscape of infinite suffering that the only health care you’ll want is the sweet release of the grave.
And that’s not to mention how hard any of these plans would be to actually pass through Congress.