by Lambert Strether of Corrente
Elizabeth Warren posted her health care plan to her campaign site on September 12, the morning of the third Democrat presidential debate. This will be a short post, since there’s not much to it, and what is missing is more notable than what is present. Here it is.
Does Warren Support Any Existing “Medicare for All” Bill?
Here is a handy chart of all the health care bills in the hopper from Vox; you will see there are two single payer/Medicare for All bills:
One bill is HR1384 (Jayapal); the other is S1129 (Sanders). They are not identical. (Jayapal’s bill is better, for reasons I explain here.) Does Warren support both? One? Neither? This is her campaign site, and she does not say. How can you have a “plan” that doesn’t even mention proposed legislation?
Does Warren believe that “Medicare for All” means “Single Payer”?
Grizzled veterans of the fight for single payer will remember that “Medicare for All” was adopted for branding purposes, since Medicare is a well-known and supported program, and “single payer” is wonky and requires explanation. However, readers will also be aware that Medicare suffers from a neoliberal infestation, and that key features like “free at the point of care” (i.e., no co-pays or deductibles) that single payer advocates regard as essential are missing from it. Further, liberal Democrats (as in 2009) have introduced considerable brand confusion, as with Neera Tanden’s “Medicare Extra,” “Medicare for All,” and so forth. Jacobin comments:
[I]t’s not intuitively obvious what “single payer” means, or why one payer would be more equitable and efficient than multiple payers. “Medicare for All” is essentially a way to quickly describe the concept to an American audience, for whom the federal Medicare program is a familiar referent. The robust single-payer system conceptualized in Sanders’s and Jayapal’s bills goes much further than existing Medicare, which includes significant cost-sharing and large roles for private insurers. But that’s too much to squeeze onto a campaign button.
As a slogan, “Medicare for All” has proven to be popular but porous: it polls differently depending on how questions are phrased or what elements of the plan are emphasized, and has also been widely co-opted. Candidates like Kirsten Gillibrand and Kamala Harris have both claimed to support “Medicare for All,” only to clarify later they meant something akin to an optional buy-in to a Medicare-esque program. The Center for American Progress’s “Medicare Extra,” eventually put into bill form under the title “Medicare for America,” likewise draws on the popularity of “Medicare for All” while describing a significantly watered-down version of what Sanders and Jayapal mean by the phrase.
So, it’s really not enough for Warren to say “I support Medicare for All,” because Gillibrand and Harris both said that, and didn’t (Harris backing off in particularly crude fashion). It’s especially not enough when there are two Medicare for All bills on the table, and Warren refuses to say that she supports either one. Here’s Warren crawfishing in a particularly obvious way; the reporter doesn’t call her on it, naturally:
Asked if she will present her own health care plan, @senwarren says she already supports Medicare for All: "This isn't some kind of contest" #DemDebate https://t.co/Ffui0utwux pic.twitter.com/dIhqHZxGTK
— CBS News (@CBSNews) September 13, 2019
“I support a lot of plans.” C’mon, man. All that said, here is the heart of Warren’s plan, which would be more fairly characterized as a set of aspirations, rather than a plan:
Elizabeth supports Medicare for All, which would provide all Americans with a public health care program[a]. Medicare for All is the best way[b] to give every single person in this country a guarantee[c] of high-quality health care. Everybody is covered[d]. Nobody goes broke because of a medical bill. No more fighting with insurance companies[e].
[a] We have heard the claim of universality before; ObamaCare advocates claimed that ObamaCare provided universal coverage long after it was obvious that it did not.
[b] But not the only way (“I support a lot of plans”).
[c] “Provide” a “guarantee” is not the same thing as universal enrollment; an advocate could make the case that any of the plans on the Vox chart above met this aspiration.
[d] “Covered” by what? A universal benefit, or a mix of public and private insurance (again, remember, capable of being branded as “Medicare for All”).
[e] “No more fighting with the insurance companies” implies, but most definitely does not state, that there will be no role for private health insurance (except for edge case niche markets).
The basic business model of an insurance company is to take in as much money as you can in premiums and paying out as little as possible in health care coverage.
Why is this paragraph even here?
That leaves families with rising premiums, high deductibles[a], and fighting with insurance companies to try to get the health care that their doctors say they and their children need.
[a] Implies, but most definitely does not state, that Warren’s version of Medicare for All, whatever it turns out to be, will have no deductibles (or co-pays). Jayapal’s bill has “no deductibles, coinsurance, copays, or similar charges.” The Sanders bill is the same, except for a cost-sharing maximum of $200 for pharmaceuticals. Presumably Warren, a careful writer, would have said “free at the point of care” if she intended for that. So what does she intend?
Insurers protecting their bottom lines restrict your networks of providers and stand in the way when you want to see your doctor or need to see a specialist without going broke.
[a] Implies, but most definitely does not state, that there will be no role for insurers (i.e., multiple payers, not a single one).
Medicare for All solves these problems. Everyone can see the doctor they need. Nobody goes broke. And your doctor gets paid by Medicare instead of fighting with an insurance company[a].
[a] Implies, but most definitely does not state, that there will be no role for insurers (i.e., multiple payers, not a single one).
Every American should be able to get the care they need when they need it. This is a goal worth fighting for, and Elizabeth is in this fight all the way. That’s why Elizabeth will fight for[a] Medicare for All.
Nonsense, useless liberal “fight for” rhetoric aside, “I support a lot of plans” is not a fighting stance. “I support a lot of plans to invade Europe” isn’t what we would expect from General Eisenhower, for example, when planning D-Day.
What Is The Role of Private Health Insurance in Warren’s Plan
Above, we saw the following artfully worded passage from Warren’s “plan”:
Medicare for All solves these problems. Everyone can see the doctor they need. Nobody goes broke. And your doctor gets paid by Medicare instead of fighting with an insurance company[a].
We noted:
[a] Implies, but most definitely does not state, that there will be no role for insurers (i.e., multiple payer, not a single one).
And so we read on, and come to this:
Across the country, barriers to coverage, disappearing hospitals and health facilities, and a shortage of health professionals are denying rural communities the high-quality health care they deserve. Medicare for All will mean access to primary care and lower health costs for patients — and less uncompensated care for rural hospitals, helping them stay afloat.
Ah, “access.” Our favorite word. Moreover, “lower health costs for patients.” Why would there be “lower health costs”? Who will be billing patients for what, and why? Will there be co-pays, deductibles, coinsurance, and other similar charges? Will there, in fact, be a role for private health insurance, perhaps heavily regulated? Why would there be any “uncompensated care” at all, if in fact by “Medicare for All” Warren means a universal benefit? We can’t know, because Warren doesn’t say. What I say is that you should go back through Warren’s prose in the previous section and assume that her answer to the question “Does Warren believe that ‘Medicare for All’ means ‘Single Payer'”? is not “Yes,” but “No,” that there will be a role for insurers (multiple payers), and that she supports complex elibility requirements like co-pays and deductibles.
Conclusion
Warren: Still crawfishing on health care. She should come out with, well, a plan. Say, to support either Jayapal’s bill or Sanders’ bill?
33 comments
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Check and see if any of these donated to her:
https://www.axios.com/tag/ceo-pay/
“The chief executives of 177 health care companies collectively made $2.6 billion in 2018 — roughly $700 million more than what the National Institutes of Health spent researching Alzheimer’s disease last year, according to a new Axios analysis of financial filings.”
Look for the Senate campaign, supposedly isn’t accepting corp contributions now.
But anyway why should Warren have to say what she supports when she is a co-signer of the Sander’s bill. This is silliness.
Now the question of who do you trust, and what will they prioritize is worthwhile (and the money they take figures in)
because cosigning the sanders bill doesn’t commit her to any course of action, and prioritizing fighting corruption doesn’t preclude taking a clear position on other issues?
David Gergen said the quiet part out loud about this:
https://twitter.com/pauldecristofo4/status/1173377307052072961?s=21
Absolutely. Thanks for this.
“Free at point of care” may be a good selling point, but the foreign systems that include some kind of copay and deductible (eg France) generally work better than the systems that don’t. With copay the patient is ‘invested’ in the service and doesn’t overuse.
Care to share some evidence?
When a patient is ‘sick’ and in need of medical care, copays are not an ‘investment’ but a ‘barrier’. That’s why copays reduce use, not sickness.
Japan has a system of co-pays that are fairly high – 20-20% – but limited to about $500/month. Because prices of procedures and drugs are regulated by the government, people know they’ll be paying 2030% of a reasonable, knowable price, and that they won’t be hit with a huge bill because of the monthly cap. I could live with such a system, though I’m not poor and not chronically ill. I don’t think the overuse argument is persuasive. Better people see doctors early, even if they see them too much in some cases. In fact, in Japan, it’s said that it’s the doctors that drive use because they tend to make up for lower prices with frequent procedures. A problem I’d rather we have as opposed to underuse, as long as iatrogenic injuries and disease don’t result.
Copays are the quaint way that insurers say they try to avoid the “moral hazard” of people actually wanting to receive health care. Funny that we consider receiving health care immoral or a medical loss to insurers, but there is no moral hazard in bailing out banksters or other wealthy parasites.
Warren is sounding like Bubba “I feel your pain!” Clinton: mouthing the right sounds while giving herself
plenty of outs (“I never said that!”).
She is not to be trusted, IMNSHO.
I don’t know her ultimate beliefs but I think what it all boils down to is: it’s not a priority (and thus the vagueness). This I can actually understand. I’m not sure prioritizing everything is possible. But running on pretending to is still popular …
But picking and choosing may be the reality (and ALL of this is assuming Dems get the Senate, if not, we’re not getting any healthcare policy period and we may as well just vote on who will be good on staffing and executive orders etc. – Bernie will be good on this stuff mind you).
But as for Warren and priorities, I do question her choice of priorities. Apparently he priority is corruption. So then the question is, is corruption the the hill to die on? I need some convincing on that one.
re: well just vote on who will be good on staffing and executive orders
especially “who would use the bully pulpit against austerians in Congress”. I trust Sanders to do this more than any of the alternatives.
Spend 2 years campaigning against the austerians in Congress, and years 3 and 4 could be miraculous.
Last year and the early part of this year, I was skeptical of Warren, her ties to Obama, the fact that she spoke loudly but nothing was ever really done and there were always excuses why.
It seems pretty evident to me she is a slicked up 2020 version of Obama. The other day a lot was made of some Wall Street types going after her, but they were all hardcore Republicans. I don’t see, for instance, Jamie Dimon, or Goldman, openly opposing her.
She’s never really done anything for consumers or the “90%”. Wall Street has written all of the reform legislation. No one has ever been prosecuted. “Fines” are an absolute joke and trumped up in value exponentially. Buyer beware on Warren.
She’s never really done anything for consumers or the “90% Huh ? Wasn’t she the one most responsible for the consumer protection bureau, you know, the department that was attacked constantly and has been reduced to almost nothing because of it’s effectiveness ? I’m not a Warren fan but she HAS worked for consumers and would continue to do so were she elected.
was it reduced to almost nothing because of its effectiveness, or simply reduced to almost nothing?
she doesn’ t need to be president to work for consumers.
> worked for consumers
Exactly. But I want somebody who works for workers.
Workers are consumers (as much as I hate the word). In fact, they are the majority of the consumers, and the ones who need most the protection IMO, because they can least afford the products being duds and lemons.
There are examples of where what is good for consumers is bad for workers (price drops driven by offshoring work), but I can’t see consumer protection example (that would be bad for a majority of workers or not compensated by the benefits to more people that it would cause trouble for).
Not the same. If you put markets first, then you see the essential social function of workers as consumption. If you put workers first, then you see the essential social function of workers as… empowerment.
Uh? essential social function of workers is empowerment? Sorry, that doesn’t even parse.
Workers work. The product of work is a service or some good. Service and a good both need to be consumed, otherwise the work is a bit pointless [it may be consumed by the worker him/herself, and sometime it may be hard to distinguish what is the “product”. Some people grow the veggies for the fun of it. If the produce gets consumed, good, if it doesn’t they still get satisfaction of the work put in. The “satisfaction” here is arguably what they “consume”, and what contributes to their wellbeing).
People, first and foremost, want to have good life for themselves and their kids. That _definitely_ involves consuming, because we have to do it to survive. For most of people, it also involves something else, to give them satisfaction, self-worth etc. In the best world, those two live side by side. But in a world where either side gets preferred, it gets corrupted – extreme US consumerism on one side, where “consumer” is everything, and extreme Soviet “workers” where work is what matters, not whether it actually does something even remotely sensible (hence my jobs-guarantee dislike. Soviets did it, it was horrible, and ended up as a weapon of oppression. No-one has ever explained ot me how JG run by a government can be prevented from being mis-used by the govt…).
Anyways, going back to the original point – I challenge your assumption that there has to be a social function of anyone that is class-specific as opposed “be the best human being you can”. That implies that you KNOW what the human society’s goal is or should be, and how the “social function” makes it happen.
Well defined class-based social function was necessary when your society was small, simple, and needed it for its survival (which was the goal).
If the goal of human society is still pure survival, then democracy is the wrong form of organising it.
If our goals are more complex (happines and all…), then I believe our society is way too complex for class-based-social-function stuff, because we have too many roles with too many complex interactions.
I’m biased here, as “social function” triggers my “Soviet block ideology” response and all that comes with it.
No, you really are missing Lambert’s point. In a system where everything is conceptualized as a market, people are not necessary to do work. They may still do work, but they could be replaced by robots or AI. Their one irreplaceable function is as consumers.
Duh. She is a senator. As a senator, she gets to try to pass a legislation. She did pass (as pointed above), the consumer protection beaurau. Which was defanged by Trump, which she could not really do much against.
She was one of the few people who grilled WF CEO, and while CFPB (above,before being defanged) fine was not large (100m), it led to subsequent larger settlements. Still, yes, 1bln total to WF was small change, and CEO wasn’t prosecuted.
But TBH, Warren as a senator could not set the fine, nor could she trigger criminal investigation of the CEO.
Warren (and AOC now) are about the only two people effective in any financial instituion commitee hearings, dragging out stuff that mose bankers don’t want mentioned.
And Warren had a fight with GS CEO about a year ago, and blasted Dimon as recenly as a few months back on JPM trying to revive the arbitration policy.
Do I think Warren is the “Chosen One”? No way. But, unlike Obama, who never did anything but talk, Warren actually made things happen. Is she as radical as Bernie? Again, no. But Bernie was what he was all his life. Warren’s beliefs started to change only a couple of decades ago – and only some of them.
If she gets a chance, she won’t be Bernie. But IMO it’s very unlikely she’d be Obama either.
bernie isn’t radical. i don’t know whether warren’s beliefs changed, or the republican party changed around her. i think she’s honest about enforcing some rules. i don’t trust her to reset the framework if that is needed (and i think it is).
> it’s very unlikely she’d be Obama either
Please re-read the post.
We have a candidate who constantly repeats that they support Medicare for All, and markets themselves as having “plans.” The we look at the actual plan, and we see that they do not support Medicare for All, and that it’s totally unclear what they do support.
In what sense is that not “being Obama”?
I’m making this comment as an elected official (Mayor), who is in his first term of the first office (board, commission, whatever) and is a long time reader of this blog (at least since 2009).
You’re right. It doesn’t mean much to say you just support Medicare For All. It also doesn’t mean much to have a plan that that’s extremely detailed that you are then going to have push though the House, and, if we’re lucky, a Senate that will comprise folks like Joe Manchin and Jon Tester.
None of these plans are getting passed in the form they are in, even if we’re lucky enough to get that Senate.
What I want her to do is to hammer away on the moral issue of universal health care, and to build the support that will be necessary to get something better than Obamacare 2.0 passed. She’s not going to do that by getting into the details of a plan that no convincible voter will understand, that the right wing noise machine will take out of context and attack, and that has no chance of passing in the detailed form you’re asking for anyway.
Now if she came out and made a moral argument that people don’t have a right to health care, I’d have a problem. But I want her (or someone else who can actually get a good bill passed) elected, and I want her to build that support for universal health care all the way through November and beyond.
This smacks of quibbling over the style of the interior decoration on the 85th floor of a building we haven’t found the money to buy the land for yet.
A particularly good dig down into the somewhat murky terrain of things said, and not said, that quite likely for the most part accurately suggest leanings and beliefs even Warren may not be fully aware of. I suspect she is sincere, but from 5000 feet, she seems to be convinced that incremental change is a fair trade off for getting along with the Washington consensus and getting something done. She comes accross as even enjoying the prospect of tough dealings and back and forth, give and take and may consider herself quite adept at holding the line when critical. Unfortunately, as has become plain to many, such confidence is mistake number one. There is no “art of the deal” when the financial stakes are high enough; only the art of being worn down and watered down till “strategic moves” are just another term for abject capitulation with bragging rights.
> A particularly good dig down into the somewhat murky terrain of things said, and not said
Thank you. Warren’s “plan” is so shallow I didn’t even have to put on my yellow waders.
If I want a waffle I’ll go to IHOP.
Also, one can do the same thing of looking at all the plans on her campaign site, and not finding a single one about empowering labor (at least I couldn’t).
I wish that Vox’s chart comparing the health care bills had a column for how each bill plans to bring down the cost of health care. Not just with respect to insurance and pharmaceuticals, but also, as Elizabeth Rosenthal emphasized in a recent NYT op-ed (https://www.nytimes.com/2019/09/01/opinion/hospital-spending.html), with providers, hospitals, etc.
As far as I know, Bernie Sanders is the only candidate who consistently talks about cost control as an important factor in reforming health care in this country. When others say, “You can keep your private insurance…” I always think “Okay, then where is the leverage going to come from to drive prices down to the level of (reasonable) costs?”, but they never seem to get around to explaining that.
Along with universal coverage, government price control has always seemed to me the whole point for having a single payer system. As reader Dwight pointed out in an earlier comment to be the case in Japan, you can have price control and universal coverage without going all the way to single payer. If any of the other candidates’ plans are proposing that as a plausable compromise between our current (non-)system and single payer, I’m not aware of it.
Vox’s columns two and three are such transparent BS. It’s like having a checklist for cars with entries like “Do the windshield wiper blades properly fly off and impale unsuspecting pedestrians?” and “Can you rest easy in the certainty that the shock absorbers will melt in the summer heat?”
Change the headings to “Your healthcare won’t be held hostage by your employer” and “Healthcare is a human right” and change the checkmarks to Xs and vice versa. Whoa, now the first two rows are solid green checkmarks and all the others have red Xs in them, funny how that works.
I can’t find it now but a while back on Nakedcapitalism (some time in spring or summer), there was an article saying that Warren’s healthcare plan was better than Bernie’s (I can’t find it now, but I’m 10)% sure of it). I don’t really have the time to actually read these plans–what gives?
Warren, or Jayapal? I’m 100& certain I never wrote a post saying Warren’s plan was better than Sanders, even leaving aside the fact she didn’t post a plan ‘til September 12, 2019.