Here are the four major health-care plans in the Democratic presidential race, from least to most aggressive:
Joe Biden. Biden’s plan would create a new government insurer — a so-called “public option” — that would compete with private insurance companies in the open market. This new government insurer would give health insurance to millions of Americans and aim to drive down exorbitant costs by creating competition. This differs from a “Medicare-for-all” system in which all existing insurance systems are folded into one single-payer plan.
Biden’s plan would not be as disruptive or expensive as single-payer, but it would also leave millions of Americans without health insurance and not eliminate medical bills.
Biden’s plan would automatically enroll in the government plan the approximately 5 million Americans who live in poverty in states that did not expand Medicaid. He would also make the federal subsidies under Obamacare substantially more generous, giving middle-class tax credits to reduce their premium charges. His plan contains other changes, such as outlawing surprise medical billing, using antitrust powers to break up health-care corporations and limiting prescription drug prices.
Pete Buttigieg. Buttigieg’s plan is similar to Biden’s: Both would create a new public option that competes with private insurers. Both would enhance federal tax credits under Obamacare for middle-class health-care costs. And both would leave private insurance largely untouched.
Buttigieg proposes doing more than Biden in a few small but important ways. Unlike Biden, Buttigieg is also pushing a hard cap on out-of-pocket costs for seniors in the existing Medicare system.
Perhaps the key difference between these moderates is that Buttigieg would automatically enroll people in plans on the public option if they’re eligible. He is silent on what happens to people who refuse to pay after being automatically enrolled, but says he will create a backstop fund to pay providers “for unpaid care to patients who are uninsured.”
Buttigieg’s plan, like Biden’s, is estimated to cost about $1 trillion over 10 years, far less than the $30 trillion sticker shock that comes with the liberals’ single-payer plans.
Elizabeth Warren. Rhetorically, Warren has aligned herself with Sanders’s “Medicare-for-all” proposal to establish a single-payer system. But she has proposed that America first approve a public option and not pass a single-payer system until the third year of her administration.
Warren’s public option would be substantially more aggressive than that of either Biden or Buttigieg. She would automatically enroll everyone younger than 18 into the plan and not charge them any premiums, guaranteeing free insurance to all children. It would also be free for everyone earning 200 percent of the federal poverty line (about $51,000 for a family of four). The existing Medicare program would also expand dental benefits to its existing population.
But Warren’s plan stops short, at least until year three, of pushing for a single-payer plan that would move all Americans — including the 150 million or so who get their insurance through their employer — onto the government plan.
Unlike Sanders, Warren has insisted she can pay for single-payer without raising taxes on the middle class, instead putting the burden on the wealthy and businesses. Some economists have questioned that claim.
Bernie Sanders. Sanders’ plan, the most aggressive in the race, would amount to the biggest transformation of the American health-care system in the country’s history.
Under this Medicare-for-all system, every American would be guaranteed medical, dental, vision and auditory care with virtually no deductibles, premiums or co-payments of any form. There is no apparent limit on how many times people could go to the doctor or the dentist and have the government pick up the tab.
Under Sanders’s plan, private insurance companies would all but evaporate in four years. Sanders’s bill would begin by eliminating all cost sharing in Medicare and enrolling people older than 55 and younger than 18. In the second year of its implementation, Sanders’s bill would again lower the Medicare eligibility age from 55 to 45. In the third year, the age would again fall from 45 to 35. By the fourth year, every American would be in the single-payer system.