2:00PM Water Cooler Special: Warren’s #MedicareForAll Transition Plan Is Set Up to Fail

By Lambert Strether of Corrente.

Readers will remember[1] that when Warren released her “pay for” plan, I wrote:

There are two big problems with Warren’s “plan” (A) the “head tax,” and (B) dependencies….

(B) Dependencies. Warren, to “pay for” #MedicareForAll, is going to have to ramp up IRS enforcement (remember how popular the mandate was?), pass immigration reform, and take away a slush fund from the Pentagon. In politics, as in programming, “The cheapest, fastest, and most reliable components are those that aren’t there.” If you really want #MedicareForAll to pass, why create a combinatorial explosion, a veritable hairball of political problems that will get in the way of its passing?

Third, the transition period. From Warren’s white paper:

Of course, moving to this kind of system will not be easy and will not happen overnight. This is why every serious proposal for Medicare for All contemplates a significant transition period. In the weeks ahead, I will propose a transition plan that will specifically address how I would use this time to begin providing immediate financial relief to struggling families, rein in out-of-control health care costs, increase coverage, and save lives. My transition plan will take seriously and address substantively the concerns of unions, individuals with private insurance, hospitals, people who work for private health insurers, and medical professionals who worry about what a new system will mean for them. It will also grapple directly with the entrenched political and economic interests that would spend freely, as they have throughout modern American history, to influence politicians and try to frighten the American people into rejecting a plan that would save them thousands of dollars a year on premiums and deductibles while making sure they can always see the health care providers they need with false claims and scare tactics.

Which is all fine — accepting the premise that “the concerns of unions, individuals with private insurance, hospitals, people who work for private health insurers, and medical professionals” have never been taken seriously before — but we’ll need to see how long that transition period is, won’t we? Given that #MedicareForAll is a “long-term”[2] goal?

In comments I was more direct:

[I]t won’t pass, because Warren tied #MedicareForAll to all these other dependencies.

In other words, if you want to maximize the chances of #MedicareForAll to pass, you don’t tie it to other bills that are also heavy lifts, like immigration reform. (Imagine you were an immigration reform advocate, and that Warren had tied immigration reform to cutting the Pentagon budget!) Sanders avoids doing in his funding options, so we’re looking at a strategic choice, that Warren made deliberately, that can only reduce the chances of #MedicareForAll’s passage.

Now we have Warren’s promised “transition plan,” and it makes the same strategic choice: Warren reduces #MedicareForAll’s chances of passage by introducing needless dependencies. Since this is a short post, I won’t focus on detail[3]. Here is the essential part. From Warren’s “My First Term Plan for Reducing Health Care Costs in America and Transitioning To Medicare For All“:

My plan will be completed in my first term…. I will fight to pass fast-track budget reconciliation legislation to create a true Medicare for All option that’s free for tens of millions…. And finally, no later than my third year in office, I will fight to pass legislation that would complete the transition to full Medicare for All.

So, when you strip away all the verbiage, Warren plans two pieces of legislation: Legislation for a public option in 2021, and legislation #MedicareForAll after the midterms, in 2023. (I think we can safely say that “no later than my third year in office” means “after the midterms,” because I doubt Warren plans to pass major legislation in 2022, after having just passed major legislation in 2021.) Here is why having two bills for the transition period — Sanders has one bill, that also includes a transition period — introduces an unmotivated[4], needless dependency.

First, the political calendar. Everybody knows that Presidencies have the most “political capital” at the start of their terms. Thereafter, their political capital declines, especially after the midterms. So Warren proposes to pass the weakest bill, the public option, when she is strongest, and then the strongest bill, “true” #MedicareForAll, when she is weakest. How does that make any sense? The only reason I can think of for choosing to make #MedicareForAll into a separate piece of legislation — remember, this is a bill Warren endorsed! — and then punt on it ’til after the midterms is that you don’t really want to pass it.

Second, the theory of change. Both pieces of legislation — Warren’s public option stopgap, and #MedicareForAll — will be ginormous political battles. If Warren thinks she can win either one by getting everybody “at the table,” she’s delusional; power concedes nothing without a demand. #MedicareForAll is not on the agenda because Warren and her professional colleagues decided to put it there, or even because Sanders ran on it in 2016. #MedicareForAll is on the agenda because a movement put it there. So, Warren is asking that movement to die on two hills: First, in 2021, to die on the hill of a program in which they do not believe, the public option. Then, to die on the hill of the program in which they do believe, #MedicareForAll, after the midterms. Not only will Warren be weak after the movement, but the movement itself will be weak, because it already died, as it were, on the first hill. A good commander doesn’t waste their troops. (Of course, #MedicareForAll may never come up, in which case, betrayed, the single payer movement might simply vanish from the scene. Every cloud has a silver lining!)

Conclusion

Kip Sullivan explains the history at PNHP. The whole post is worth reading, but here is the essential part:

There have been three cycles of health care reform in the last half century – 1970-73, 1992-1994, and 2007 to date. At the dawn of each cycle, single-payer legislation had already been introduced. But early in the cycle, single-payer legislation was “taken off the table” (to quote a statement Sen. Max Baucus now wishes he had never made). Each time the Democratic leadership chose instead market-based proposals that had no track record and no evidence to support them. Each time they favored reform deemed more “politically feasible” than single-payer because it left the insurance industry in place. In all three cycles, the alternative, market-based proposal was promoted by one or two policy entrepreneurs (that is to say, it wasn’t an idea that bubbled up from the grassroots).

Single-payer legislation was the first out of the chute during the 1970-1973 cycle. In January 1970, Sen. Ted Kennedy introduced what we would today call a single-payer bill. But Kennedy and other leading Democrats quickly abandoned single-payer in favor of a theory about cost containment called the “health maintenance strategy.” This strategy revolved around a new-fangled type of insurance company proposed by a Minnesota physician named Paul Ellwood that Ellwood called the “health maintenance organization.”… Thus was the world’s first HMO industry born. As we all know now, the HMO experiment failed.

Two decades later, when the 1992-1994 cycle opened, single-payer legislation was not only in place in Congress it had also been introduced in many states (the first state single-payer bill to be introduced was introduced in Ohio’s legislature in 1990). The first modern-day single-payer bill was introduced in the US House by Rep. Marty Russo (D-IL) in 1991 and in the Senate by Senator Paul Wellstone in 1992. But as was the case during the previous cycle, the Democratic leadership was seduced by an alternative to single-payer. Once again, Paul Ellwood played an important role in luring Democrats away from single-payer.

Late in 1992, candidate Bill Clinton was persuaded by representatives of a group Ellwood helped form, the Jackson Hole Group, to support something called “managed competition.” … The 1994 cycle ended with the death of Clinton’s bill in September 1994, and the unraveling of similar managed competition legislation enacted in Minnesota and Washington.

The cycle we’re in now [2007-2010] bears many similarities with the last two cycles. When this cycle began (2007 is as good a year to pick as the first year of this cycle, although that is somewhat arbitrary), single-payer legislation was better positioned than ever before to be taken seriously by Democrats. Single-payer bills had been introduced in several states as well as the US House (Sen. Bernie Sanders would introduce a single-payer bill in the Senate in 2008). Polls were showing that two-thirds of Americans and 60 percent of doctors support single-payer (or “Medicare for all”) legislation.

But once again an articulate policy entrepreneur appeared on the scene to sell a market-based alternative to single-payer that would leave the insurance industry at the top of the health care food chain, and once again the Democratic leadership fell for it[5]. This time the entrepreneur was not Paul Ellwood. This time the policy entrepreneur was Jacob Hacker, a professor of political science at Berkeley. Just as Ellwood and the Jackson Hole Group had before him, Hacker said enhanced “competition” among insurance companies was the solution to the health care crisis. (The name of Hacker’s latest paper is “Healthy competition.”) This time enhanced competition would not come from “managing” competition, but from the creation of a “public option.” This time the coalition that promoted the alternative to single-payer was not the Jackson Hole Group, but HCAN, assisted by a sister coalition called the Herndon Alliance.

We are now in the fourth cycle. We have seen this movie before. We have only to look at history to know how it ends. This time Warren, or whichever unknown policy entrepreneur wrote her white paper, is promoting a market-based option, taking on the role of Hacker and Elwood. Does anybody seriously believe, looking at the history, that after Warren’s first bill for the “public option” passes, if indeed it does, that liberal Democrats will do anything but sigh and never pass the second, “true” #MedicareForAll bill, because it’s just not “politically feasible”?

So, both Warren’s pay-for proposal and her transition plan have the same problem: Both have unmotivated dependencies — immigration reform and two pieces of legislation, respectively — that have the effect of making #MedicareForAll likely to fail. (Sanders’ plans do not have these dependencies.) Charitably, that’s because Warren has terrible politlcal judgment; and the charitable explanation may be true, because Warren does, in fact, have terrible political judgment. Less charitably, Warren wants #MedicareForAll to fail. She would not be the first liberal Democrat to want that.

#MedicareForAll. Accept no substitutes!

NOTES

[1] Readers will also remember that I looked at the “Health Care” page on Warren’s campaign site, and concluded: “Still crawfishing on health care. She should come out with, well, a plan. Say, to support either Jayapal’s bill or Sanders’ bill?” and that “I assume that Warren’s horrid, crawfishing campaign page on health care will shortly be cleaned up.” No such luck. I looked at the changes to the site on the Wayback machine, and then ran a diff on the current page versus the page that I looked at, from September 12. There was a single correction, a typo (two periods where one was meant). I suppose that means that the campaign page, the pay-for proposal, and the transition plan are all consistent with each other, and always have been.

[2] In my earlier piece, I parsed Warren’s verbiage to try to figure out what “long-term” means. I concluded it meant a maximum of two Presidential cycles. Now “long-term” means two years. So go figure. Or maybe “long-term” is there as weasel wording to protect Warren when the second, true #MedicareForAll plan fails to pass after the mid-terms. Who can tell? I do doubt, however, that Warren in professorial mode, involved in matters like curriculum development, could possibly consider two years “long-term.” Two years is barely time to set up a committee.

[3] I’m going to skip over all Warren’s Executive Order stuff, because any President can do that, and also because any President can undo that, as Trump did with a lot of Obama’s executive orders. The only thing that matters is legislation. Everything else is distraction. And here is the idiotic Tweet that introduces the plan:

(1) “Fight for” is classic liberal Democrat rhetoric. Always fighting, never winning! (2) #MedicareForAll that is (3) an “option, means-tested, and age-limited is not “for all,” duh. And “true” is the perfect [chef’s kiss] on the whole concoction.

[4] Here is Warren’s absurd justification: “By this point, the American people will have experienced the full benefits of a true Medicare for All option, and they can see for themselves how that experience stacks up against high-priced care that requires them to fight tooth-and-nail against their insurance company.” Warren must assume that none of us have parents on Medicare, or that we’re really dumb. After all, single payer advocates (controversially) chose “Medicare for All” because Medicare had good branding, based on its performance. In any case, pass one bill and then use people’s experience to amend and improve it. There’s still no need for a second piece of legislation.

[5] “Fell for it” is being extremely charitable.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.

54 comments

  1. Synoia

    Great Analysis. Warren’s plan is a Rabbit Warren, full of twisting little passages, with one entrance and the same as an exit.

    “Fight for” is classic liberal Democrat rhetoric. Always fighting, Always Loosing!

    Blunt is better.

    Medicaid for all might be better. Medicare is full of hidden $urprises.

    Reply
    1. JohnnyGL

      Medicaid isn’t single-payer. It’s 50-state payer.

      Also, MA is one of the best in the country on Medicaid and they’ll still randomly drop your coverage over paperwork issues, leave you on hold for extended periods of time, drop your call and make you start over.

      Medicaid isn’t really coverage for the poor….it’s only coverage for the poor who are motivated and well-organized. If you lack any of those characteristics….they’ll find a way to drop you.

      Reply
      1. Danny

        Under Obama’s handing over of the healthy uninsured population to the insurance monoliths, enforced at IRS gunpoint, poorer Americans were forced into this involuntary “insurance” whether they liked it or not, with the surrender of whatever they could leave their children though clawbacks of everything including the administrative costs for their involuntary coverage.

        See why Trump won?
        Grandma Warren is round two with the same result.

        Reply
        1. Amfortas the hippie

          the “clawback” feature of medicaid is something that keeps me awake some nights.
          like a bunch of other things, it’s near impossible to get a straight answer.
          there’s my 8 years of ssi/medicaid, now wife’s(dropped me the same day they accepted her, which felt sort of eerie)…and my stepdad: paraplegic vietnam vet, VA has taken their responsibility seriously with him over the last 50 years since the rice paddy outside of da nang….but he’s required to be on medicaid, too…”long term care”, at home.
          numerous google searches over the years since my crusade for a hip reveal a whole lot of chatroom anecdotes of horror stories(which reads like art bell-ish abduction tales)….and a bunch of contradictory weaselwords from officialdom(different answer every time).
          i don’t obsess over this—nothing i can do, really—but the FUD is always there on one of the mental side-tracks.

          Reply
          1. Spring Texan

            Yes. I think a lot of whether there is “clawback” depends on your state and whether they choose to pursue it. Good luck!

            I’d think that many states won’t pursue clawback over at-home care – but others will. People don’t even understand this cruel aspect of our “system”.

            I don’t think you are in jeopardy of clawback for just getting Medicaid expansion benefits IF you are under 55 though I could be wrong, but if you are 55 or older being screwed is a possibility. I have a nephew who is 59 and in this boat. He doesn’t realize they might take away the house he owns after he dies, and I’m not going to tell him. Fortunately he has no kids or heirs that would be depending on inheriting it.

            Reply
      2. Synoia

        Then we need to remove the Claw back from Medicaid, make it totally federal funded, and then provide Medicaid for all.

        Does this remove the objections, or are there other traps in Medicaid?

        Reply
        1. marym

          Medicaid is privatized as Medicaid Managed Care in many states, contracted to insurance companies, and allowed a medical loss ratio of 85% (link). There are probably other state-level differences besides the clawback, like additional services covered and work requirements.

          The Medicare name was chosen originally at least partly because it conveyed a universal (for +65) and popular system. From a bureaucratic, logistical standpoint, I don’t know what the trade-offs in complexity would be to convert one or the other to a universal, comprehensive system. Both have become fragmented with privatization, means testing, and overlap (some Medicare beneficiaries moved to medicaid managed care).

          Reply
      3. treevole

        If you are between the ages of 55-65 and you receive Medicaid, everything that is spent on your behalf including premiums paid for you (even if you did not get medical care) are due to be paid back at your death. It’s called Estate Recovery and typically the state takes your home in order to pay for it. If you thought your children would inherit your home, forget about it. It’s why I didn’t have any insurance until this year. I refused to be punished for being old(er) and poor by having my assets stripped. So instead I was punished by not getting regular medical care. What a Country!

        I had always assumed the Estate Recovery provision was in the original bill that funded Medicaid. Not so. Recently found out it was added by the Bill Clinton administration to raise revenue. Even back during the Clinton Administration, corporations and the wealthy were not paying their fair share of taxes. So Clinton did the obvious thing: get money out of poor people by taking their assets after death.

        Reply
  2. grayslady

    Elizabeth Warren is a one trick pony–financial regulation. That’s really all she understands. She doesn’t know how to create jobs, or deal with climate change, or tackle immigration. She’s still a Republican–and not the good type of Repubs I grew up with. (For those who are younger, John Anderson, an Illinois congressman who ran for President, was more liberal than Jimmy Carter, who was running at the same time.) She’s Hillary 2.0, which means she believes that all the “deplorables” need is to attend the right schools, have the right contacts, get the right jobs, and then they’ll be able to afford expensive private health insurance. Her public option stance is means tested–no different than Hillary–and I’m convinced she truly believes that a sop to those who are struggling is sufficiently socially conscious that all the clamoring for Improved Medicare for All will die down. She is wrong.

    Reply
    1. Arizona Slim

      Which is why she’s best suited for a policy-wonkish task like heading the FDIC or the Consumer Financial Protection Bureau.

      Oh, wait. She already ran one of those agencies.

      Reply
      1. Yves Smith

        No she didn’t. She was only in a transition role, “standing it up,” as she put it, a turn of phrase I dislike (it creates the image that the agency was a cardboard cutout) and was merely a “Special Advisor” to Obama. The first head of the CFPB was Richard Cordray.

        Reply
  3. jo6pac

    Well at lest in her plan at this time I get to keep my Dr.;-)

    The new rommey, obomber, warren plan because it has worked so well up to this point.

    Reply
  4. Jeff W

    There’s also another undermining dynamic at work here: let’s assume, charitably, that Elizabeth Warren with her lousy political instincts manages to pass “a true Medicare for All option that’s free for tens of millions,” (whatever the heck a “Medicare for All option” is, as you point out).

    You’ve just created a major stumbling block for single payer. Every opponent + dog now says “What do we need single payer for? Everyone who wants that ‘option’ can have it”—and Warren has successfully shot single payer in the foot.

    And, further, we’re now stuck with this crazy two-tiered system that doesn’t have the administrative efficiencies of single payer and that will be used, dishonestly, to “prove” that “Medicare for All” (which this option isn’t and can’t be) “doesn’t work.”

    It’s a colossal strategic failure, even if we assume, as Warren wants us to, that the first part of her “plan” comes to pass. The first part of her plan doesn’t support the second, it undermines it.

    Warren does have terrible political judgment and I’d say she doesn’t care at all about Medicare-for-All but I’m not sure what I’d call this—she can’t think two chess moves ahead? She’s in a hole, can’t stop digging, and thinks she’s getting closer to the sunlight any minute.

    Reply
    1. OpenThePodBayDoorsHAL

      Let’s imagine there is a politically-immovable object (private health insurers) but also a groundswell across the board demanding what the rest of the world has already deployed successfully for decades.

      Why not do what the Dutch did. Keep the private insurers in place but force them all to offer a basic set of services at a fixed cost. Now that they have you as a customer, above that they are free to upsell a variety of services (additional coverages, private rooms etc) and to compete (dog forbid) on good old *customer service*.

      Of course all in the context of a single risk pool and single payer. At the end of the day I bet insurers themselves are not all that thrilled with their costs to maintain all of the baseline copays, procedure codes, and policy revisions the current system requires.

      Reply
    2. Spring Texana

      Great summary, Jeff W. Yes, I would say that this shows that she doesn’t understand, doesn’t care about, and won’t fight for Medicare-for-All. It’s terrible. But I’m real glad her true colors on this have come out now. I’m very disappointed as I liked her so much better before but I’m also very glad she didn’t wait for the general election to pivot.

      Reply
  5. Sol

    Convincing the masses that one really, truly cares about the situation at hand is more beneficial to those in charge than altering the situation. Altering the situation will invite blame for consequences. Altering the situation is sure to gore some powerful ox. Caring very deeply, in the abstract and from 20,000 feet, is practically free.

    Not to say anything about Warren herself. I’m sure she’s a real nice person. I just don’t believe one nice person is capable of besting the incentives, regulatory capture, and structural inertia that have been built up for decades.

    We’ve created a behemoth. Twiddle at the edges so as not to disturb the behemoth, and it’ll still be a behemoth.

    Reply
  6. ptb

    Ya what she’s proposing is a bumped up Medicaid.
    If passed it would be a lifesaver for many in that 140-200% of poverty income band, but hardly M4A and doesn’t address the fundamental problem of US health care – that its structure has evolved for max profiteering.

    Also a bad move politically – she’s gonna lose support w/ the meat of the likely voter distribution once they figure it out. Without reining in the insurers and hedge funds who bought our hospitals, the effect will be to drive yet another a wedge between low and middle income people…

    Reply
    1. Spring Texan

      This! Your description of it as a “bumped-up Medicaid” is on target.

      Although in reality with her having retreated so much already, I don’t have an iota of faith that she’d get even that done. They’d just tweak the ACA a little more . . . a la Biden.

      Reply
  7. JBird4049

    How typically deceitful. Let’s not meet real need, but just put on a Kabuki to shut the peons up.

    The earliest national system that I know of was set up by Chancellor Otto von Bismarck of the German Empire. An arch conservative. Since then, under presidents Obama, Clinton, Nixon, Truman, FDR as well as some rumbling during the Progressive Era, there have been real attempts to create a national healthcare system; they always almost succeed in creating a system successfully started with *every* major European country plus Japan and Taiwan.

    Frak this. I am a widower because of our healthcare denial system. Whenever I see such proposals as Warren’s nonsense or excuses for why we cannot have what almost a billion other people have, I want to scream.

    Reply
    1. OpenThePodBayDoorsHAL

      I so feel for you. My best possible mate in the universe departed due to the previous health scam known as the HMO. Sent him home repeated times, no tests allowed, until he finally presented with Stage Four liver disease.

      Reply
      1. Sol

        To you, OTPBDH, and to JBird, and to the many readers recently who have opened up honestly about their lives and pain, I am so sorry for what has happened. I wish I could offer real hugs, but please take instead my admiration that y’all had enough strength left inside after all that to also speak about it.

        Cheers.

        Reply
        1. Amfortas the hippie

          virtual hugs are recommended at this time….there’s a flu outbreak at the high school. Wife’s oncologist all but ordered her to stay home this week(on the chemo pill, altho her blood counts look great)
          half the senior class is out…and all of those didn’t get the flu shot….due to neglect, “i forgot”, too-busy-ness or having fallen prey to the alex jones-esque fear of immunisation.(we’re close to the school nurse, so have the inside track on such things. nurse likes me because she gets to chew fat about epidemiology,disease surveillance, etc)
          so after this week, she’ll be teaching spanish in a mask(I have strongly advocated writing a message on that mask:”i hafta wear this because you didn’t get a flu shot”)

          boys hafta go, of course…they are well schooled in procedures to mitigate exposure(like “left hand for doorknobs, right hand for scratching one’s nose”)…and if that fails, they are even more well schooled on quarantine procedures at home.
          it doesn’t have to be this way.

          “access to care” is the very large tip of a much larger iceberg of dysfunction in our “best healthcare system in the world”.

          Reply
    2. Spring Texan

      Great bringing in the Bismarck system. Yes, why don’t people look to history to see what worked. Looking at Aneurin Bevin and the inception of the NHS is also very instructive . . . and speaks well for NOT having gradualism. This is not a place gradualism is ever going to work.

      Reply
  8. Fred

    Let’s face it a GOP controlled Senate has everything the Dems propose up for failure. Especially anything they can label as socialist.

    Reply
    1. Sol

      People can now claim using the word ‘we’ too often is socialist.

      When “We, the People,” becomes dangerous pinko hippie talk in one’s worldview, it would be nice to think folks might reconsider this line of thinking, and yet…

      You’re so correct. Valid point, Fred, this is a fractured society, sharp and shattered. We don’t seem to lack merely the ability to communicate and cooperate, we also seem to lack the will.

      Reply
  9. notabanker

    Important post Lambert, thanks for writing it.

    Non-MNC American corporations are in a huge crisis. The US healthcare system is wiping out their workforce and customer base. This isn’t about the 100-200% poverty band income. This is about anyone making less than $100K being wiped out because of a health issue and those making north of that having their financial future stripped away from them, for decades or life. This fight is literally for the country’s survival and Warren is not the person I want fighting it.

    Reply
  10. ChrisPacific

    And finally, no later than my third year in office, I will fight to pass legislation…

    Can’t start fighting in year one, you know. Gotta lay the groundwork first.

    Reply
  11. Joe Well

    Lambert’s argument here is convincing.

    I am less convinced by Matt Stoller’s defense of Warren’s M4A proposals, and he is her most credible champion I know of.

    According to Stoller:

    1. Government has been so destroyed by neoliberalism that a Sanders-style M4A is doomed to failure if it moves too fast, so we need a Warren-style transition.
    2. People distrust government after the Obamacare disappointment and are afraid of losing employer-based care, so it is better to ease them into M4A.

    And I can only wonder why he thinks people aren’t even more scared of the disaster that is healthcare provision today. And why he doesn’t see the urgency of beating the economic life out of that evil industry as soon as possible before they can mount a strong counterattack.

    Reply
    1. JohnnyGL

      I’m a big Stoller fan….he’s being foolish on this. I’m also a Warren defender as I’ve been following this blog since 2007 and remember her actions during the financial crisis quite fondly, but this isn’t defensible. She’ll please no one and intensify the doubters. The media will smell blood in the water for Wednesday’s debate and they’ll go hard at her on this. She’d better be ready. This isn’t DNA test level bad, but it’s the kind of thing that helped kill the Harris campaign.

      I’m going to update Lambert’s sea-creature comparison. She’s not crawfishing anymore. Now she’s just flopping around like a fish out of water.

      Reply
      1. Hepativore

        What Stoller and other people who would settle for a public option do not seem to realize is that the same neoliberals who would oppose a single-payer system would also defund or cut back a public option. Future Democratic presidents would also offer to hack a public option program to pieces in exchange for the hope of getting non-existent Republican support for their other policies. Substitute “public option” for Social Security in future “Grand Bargains” and you get the picture.

        In a few years, a public option will be reduced to something like Tricare, and it will be a huge dumping ground for private insurers to offload the poor and severely ill onto. There is also the fact that a public option will be eventually gobbled up by the process of privatization like everything else has been under neoliberalism and then we will be right back where we started.

        As for people not trusting the government after the failure of the ACA, that may be, but they hate private insurance companies even more. I think that they are more embittered over the Clinton/Obama wing of Democrats selling them out after all of the 2008 rhetoric of “Hope and Change” then they would be against a single-payer system.

        Americans are already afraid of losing their employer-based care when they are downsized or change jobs and many employers do not even offer health plans. Even if they do, a lot of places simply do not pay their employees enough for anybody to purchase an offered plan and the deductible is often so high that they would be paying premiums for a plan that they cannot afford to use.

        What people want is a politician who wants to overhaul the entire healthcare system and is willing to back up the said rhetoric of doing so.

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        1. Spring Texan

          This is so right, Hepativore. They don’t seem to understand how things work at all! Your description is flat wonderful in its accuracy of what any “public option” – if they even did one rather than just ACA tweaks – would be in actuality. Thank you!

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    2. VietnamVet

      I agree with Matt Stoller. Except it is even worse. The public health system and county hospitals that treated anybody are gone. There are haves and there are have-nots. It is like the Soviet Union, when the USA collapses, the first thing to go will be government pensions and Medicaid. The gated communities in the Hamptons are indefensible. To avoid a collapse, you can tax the haves but you cannot take away the health insurance they already have. They don’t trust government to replace it. But they will accept a withdrawal from the Middle East and an end to the Cold War to pay for it. A system that pays the existing doctors, hospitals and pharmacies for everybody and that is familiar; Medicare for All. Private insurance continues if they can afford it or it’s a job’s entitlement. It all must be implemented by civil servants not contractors through the new President’s first term.

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    3. lambert strether

      Warren defenders tend to confuse “transition” with Warre’s two pieces of legislation. In fact, Sanders has a more-than-ample four year transition, and achieves Warren’s putative goal of showing the American people what they already know, i.e., that Medicare works, in simpler fashion, by lowering the Medicare age requirement.

      I think Stoller and to be fair most commentators underestimate the ferocity with which not only the health insurance industry but the worst elements of the Democrats and the press will oppose #MedicareForAll.They will oppose Warren’s stopgap or Sanders real #MedicareForAll with equal zeal. Any liberal Democrat who collects rents from the current system (many, like Warren’s body shop-running daughter) or who hates the working class (most, see Thomas Frank) will join the, er, resistance to #MedicareForAll. They’ll be harder to beat than the Republicans, because they still retain some brand fumes of of good faith. So why not fight one enormous battle for the right thing, instead of two, one for a stop-gap?

      There is an argument to be made, which Stoller has made, about hysteresis; it’s not so easy to spin up a government department if you have to draw from a population that believes big gummint is the enemy. However, that doesn’t justify two separate bills. In fact, two bills make it harder by postponing the reckoning with real #MedicareForAll.

      Reply
      1. scarn

        Very well put. Even if we are to believe that Warren is serious about an eventual m4a enactment, another strategic concern is about “how to fail”. We demand m4a because a compromise must be acceptable and available. Remember that we will need to force 75% of congress to do this through non-electoral actions. If that pressure falls short, then the secondary redoubt should be beyond warren’s maximum request. We literally get nowhere by politely asking for her silly plan and having it fail a committee vote. Disappointing to see a good guy like Stoller completely misunderstand the power dynamics here.

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  12. TroyIA

    If anyone has doubts about who Warren’s plan will benefit just check out the stock price of companies like United Health over the past few days.

    Reply
  13. richard

    “free for millions”
    i can just imagine my red state idaho sister with steam coming out of her ears
    and I’m with her there
    why the hell would anybody support that?
    eligibility tests are another way to guarantee failure
    for the bad on purpose dems

    and if i can add my thanks for this really excellent and useful analysis.

    Reply
    1. peonista

      I work at a small non-profit that does not offer health care. We all either have insurance through a partners work or are on the dreaded “exchange” that Obummer brought us. We have high deductibles, co-pays, network restrictions, the whole nightmare of US healthcare Inc. Most of us seldom go to the doctor unless it is an emergency.
      Our poor clients who have Medicaid, in contrast, call the ambulance to be transported to the hospital that is 5 blocks from the shelter. They come in with giant bags of expensive drugs, which they often leave behind when they exit unexpectedly. They go see the doctor if they have a head ache or a cold.
      I know there are complicated reasons why they do what they do. No car, no mass transit, thus the ambulance ride. The “status” of having the attention of and getting seen by medical professionals and being diagnosed. The fear of Children Protective Services second guessing their parenting decisions. The medical profession over prescribing medications and procedures to the Medicaid funded population.
      Even at my work, where we are social workers this 2 tiered health care system produces resentment. The workers who are cannot afford to access the level of care their clients have access to resent their access. It also cements in their mind that national healthcare would be unaffordable because it would be incredibly abused.
      I know this is all deliberate. The old “Divide and conquer” adage. If I know this it makes me suspicious of the intent behind stupid plans like Warren’s. Surely she can’t really be this clue-less.

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      1. anon y'mouse

        the lady made public her DNA test to “prove” her claims of minority heritage, which she has tried to capitalize on with the modicum of preferential treatment doled out to those of that ancestry. long after the hubbub had died down over her “claims”. so, she dragged her own skeletons back out of her own closet to shake them bones in public.

        yes, she can be this clueless. and always has been, it seems.

        Reply
  14. Misty Flip

    Or the bookish Warren knows her history when it comes to transformative legislation passed by FDR and LBJ during their first terms. First, pass some good things immediately to win more support by gaining Congressional seats after midterms. Then you pass the great things: social security and voting rights act. M4A will never pass this Senate or the next class. But with momemtum, the third class might be faced with an electoral arm-twisting ahead of them if a Pax Warren-na looks inevitable.

    Reply
    1. lambert strether

      If you look at history, Warren’s proposed stopgap will destroy momentum toward #MedicareForAll, as it has three times before, You did read the post, didn’t you?

      Reply
  15. JD

    Don’t forget that the party of the president almost always loses seats in the House and Senate in their first midterm, and usually loses one or both majorities if they had them. Based on very firm historical precedent, it’s extremely likely the Republicans will win the House or Senate in 2022, making any future bills impossible.

    Reply
  16. Off The Street

    Political capital.
    That phrase became known to the average citizen during the reign of W. He told people that he had it and intended to use it. Did he ever, and we are still paying the price. Capital raising and allocation take on new and distressing meanings in the DC world, where one needs a translation dictionary to find out what is really meant, at that time, in those circumstances.

    Reply
  17. SpringTexan

    I’ve tried twice to post a comment with a link to a blog post about this, and neither comment has appeared. Although all my other comments on this topic made the cut, neither was posted nor did I get any notice that a moderator might need to look at, so I’m puzzled. Anyhow, I’ve written on “Cutting the Gordian Knot: Why a ‘Public Option’ Won’t Work” at the Health Care Renewal blog, in response to Warren’s transition announcement.

    Reply
    1. grayslady

      My favorite quote from the piece:

      A tweet from @SableViews makes the point in a different way that incrementalism can be a horrible strategy:

      ” You can’t leap a chasm in two bounds. So what does [Warren] suggest? Break the leap into two bounds so that M4A falls down the damn chasm never to make it to the other side.”

      Reply

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