December 08, 2019
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Elizabeth Warren has a smart hedge on Medicare for all

John Locher | AP
John Locher | AP
Democratic presidential candidate Sen. Elizabeth Warren, D-Massachusetts, speaks Sunday during a fundraiser for the Nevada Democratic Party in Las Vegas.

Medicare for all is still Sen. Elizabeth Warren’s ultimate goal in health care. But she has another plan that’s going to come first, and it has a better chance of actually happening.

Warren, one of the leading Democratic candidates for president, released a transition proposal Friday that would make sweeping changes to existing government health care programs in her first days in office, creating a generous new public plan available to most Americans, and free to many. It’s meant to be an interim step on the way toward her ultimate goal of a single-payer system that would eliminate private insurance — something she doesn’t envision being rolled out until as late as the third year of her theoretical first term. While billed as a “transition” plan, the proposal is still plenty ambitious, and a smart move by her campaign.

She is effectively acknowledging that Medicare for all remains a controversial policy that doesn’t have the full support of congressional Democrats. The interim proposal has a little something for everyone: It would make a transition to Medicare for all easier, whether it comes in a few years or further down the line, by moving more Americans to a public plan. It would also leave many people more generously covered, while potentially bringing down costs even if such an effort failed.

Warren’s plan has two parts. The first chunk consists of an ambitious wave of executive actions intended to rapidly bolster the Affordable Care Act, make Medicare and Medicaid more generous and accessible, and cut health and drug costs. No Senate majority required. The second requires actual legislation.

Warren’s proposal creates what she calls a “Medicare for All Option.” The name is no accident. The plan goes much further than the public options proposed by more moderate candidates such as former Vice President Joe Biden and South Bend, Indiana, Mayor Pete Buttigieg. It offers substantially more generous coverage, auto-enrolls a bigger chunk of the population, and would be free for many Americans. People who prefer private plans could keep them, though Warren expects the number of people who make that choice to get pretty small pretty quickly. All of that adds up to a more expensive plan than what Biden or Buttigieg have put forward, but Warren’s proposal also includes much more expansive and substantive cost controls than either of them.

Warren doesn’t give a price for the interim option but expects that it would cost less than the $20.5 trillion in new federal spending she projects Medicare for all will require over 10 years. The plan’s cost, structure, and comparative moderation should make it easier to pass via the reconciliation process and with even a slim Democratic majority in the Senate. Passing it still won’t be easy, but it’s a more realistic and quicker option than needing to end the filibuster or immediately shift to a single-payer plan.

Warren will still have to go and defend her approach to both Medicare for all absolutists and more moderate rivals. But she has better answers for both now and offers an appealing third path; more realistic than Vermont Sen. Bernie Sanders’, more ambitious than Biden’s or Buttigieg’s.

Max Nisen is a Bloomberg Opinion columnist covering biotech, pharma and health care.

 



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