Medicare For All activist, Ady Barkan, who is dying from ALS, released an op-ed piece for The Nation explaining not only why he's endorsing U.S. Senator Elizabeth Warren (D. MA) in the Democratic Primary but also why he is backing her plan to transition into Medicare For All over U.S. Senator Bernie Sanders’ (I. VT) Medicare For All plan:

Since my diagnosis with ALS three years ago, I have spent much of my time advocating for Medicare for All. Warren shares that goal. And über-wonk that she is, Warren has recently articulated in detail how to pay for and transition to a single-payer health care system. I’ve written previously about why I think her funding plan is smart policy and even smarter politics. Now, I want to explain why I think the same is true of her transition plan.

The plan begins on Day 1 of her presidency, with some important executive actions to lower prescription drug prices and constrain the political power of big health care companies. Then, in her first hundred days, she will ask the Congress to pass a massive expansion and enhancement of Medicare, including a generous Medicare for All option. Here’s what that law would do:

  • Radically improve Medicare so it fully covers long-term, dental, vision, hearing, mental health, and substance abuse treatment.
  • Lower the eligibility age for Medicare to 50, giving 57 million people the ability to enroll immediately.
  • Create a Medicare for All option that offers totally free, comprehensive health care to 135 million Americans—every child under 18 and every person making at or below 200 percent of the Federal Poverty Level (roughly $51,000 for a family of four). Everyone else would have the option to enroll at low cost, capped at 5 percent of income with costs automatically going to zero over time. Giving people the ability to buy in to Medicare immediately ensures that the insurance companies won’t game the system. We know that they, seeing they are getting pushed out of the marketplace, will likely raise premiums for the sickest people and kick many off their existing insurance plans. The buy-in—which is in both the House and the Senate bills—allows us to make sure we protect everyone.

We can and should talk about our strategy and our tactics. But what matters most to me is that Warren is all in for Medicare for All. Her plan says clearly that by the end of her first term, everyone will have comprehensive guaranteed Medicare—whether you are rich or poor, young or old; that there will be no co-pays, premiums, or deductibles; and that we will bring down the costs of health care because private insurance companies will no longer be able to put profit over patients.

There are two facts about the Warren proposal that I especially like. First, it lowers the age of Medicare eligibility to 50 immediately, getting even more people onto Medicare in the first year than Sanders’s bill, which has an eligibility age of 55. Second, Warren also adds in full long-term care, which matches Representative Pramila Jayapal’s Medicare for All bill in the Hosue. That is an enormous addition for our seniors and people with disabilities. I know firsthand just what this will mean for millions of people across our country to have this kind of care available to them.

Warren’s proposal boldly states that she will use budget reconciliation to get many of the changes in her first and second year. This is important, because budget reconciliation requires only 51 votes in the Senate. Republicans use this all the time, and used it for the tax scam they passed last year. But unfortunately, even past Democratic presidents have balked at availing themselves of this simple tool. Warren makes clear that she will use all the tools available to provide Medicare for All–type care to as many Americans and as quickly as she can—and then she will complete the final part of her plan in the last two years by transitioning the remaining people into that same comprehensive care.

You can watch Warren and Barkan’s conversation on the NowThis series, Uncovered:

Not only does Warren’s plan make sense, but she also has a clear strategy on how to get this passed. My issue with Sanders is I don’t he has clear strategy on how to get his 100-page Medicare For All passed through the Senate. Sanders has also advocated for using the Budget Reconciliation Rules Change to pass Medicare For All be even the way he wants to use the route does not guarantee it would pass:

But you know what almost certainly could not pass via reconciliation? The Medicare for All bill that Sanders has proposed. The problem is that, under the so-called “Byrd rule,” the Senate cannot use reconciliation to pass regulatory changes that only have an “incidental” impact on the budget. While the word “incidental” is open to some degree of interpretation, it’s a real limitation. When Republicans attempted to repeal Obamacare via reconciliation two years ago, the Senate parliamentarian concluded that important parts of their original bill violated the Byrd rule, such as a provision that would have locked adults out of the health insurance market for six months if they let their coverage lapse.

Sanders’ Medicare for All plan would likely have trouble making it through reconciliation because it effectively bans comprehensive private insurance. That’s arguably the defining aspect of his proposal, the thing that makes it a true single-payer system, and it would almost certainly violate the Byrd rule’s restrictions on regulations that only have an “incidental” budget impact.

Using reconciliation would also make it more challenging to finance Medicare for All, since under the Byrd Rule, legislation cannot raise the deficit outside the official budget window. There are ways Democrats could try to get around that limitation—they could pass a 30 or 40 year budget resolution, for instance—but chances are, any health care bill passed via reconciliation would either have to be paid for in full, or designed to expire within a decade (much the way pieces of the GOP’s tax bill are set to sunset).

Warren was the first candidate to advocate abolishing the 60 vote filibuster, a fight that still must be fought if we are to pass a progressive agenda and overcome Moscow Mitch and the Senate GOP’s obstruction along with avoiding any kind of backlash from Blue Dog Democrats. Sanders does not support abolishing the filibuster and has claimed there are multiple ways to pass Medicare For All without getting rid of the filibuster. But he’s yet to explain these other routes and I am skeptical there are other effective ways that would achieve this within his first term. Getting the Public Option aspect first is very possible:

Even if Democrats control the entire federal government in 2021, their best-case scenario is a narrow Senate majority that would likely leave Warren far short of the votes to pass Medicare for All. And several key Democrats have pledged not to eliminate the legislative filibuster. But the party is more united around the idea of a government-run insurance option.

The budget fast-track process, known as reconciliation, has been used by majorities in both parties to avoid a filibuster. Democrats under President Barack Obama used it to pass Obamacare in 2010, while Republicans under President Donald Trump tried to use the procedure to repeal the health-care law in 2017 but came up short.

“While Republicans tried to use fast-track budget reconciliation legislation to rip away health insurance from millions of people with just 50 votes in the Senate, I’ll use that tool in reverse – to improve our existing public insurance programs,” Warren wrote.

Still, budget reconciliation creates complications as Senate rules require that such legislation be limited to changes involving taxes and spending. Republicans struggled to shoehorn their attempted repeal of Obamacare, which included regulatory reforms, into the process.

Warren also vowed to take immediate action to lower drug prices in her first day as president, including insulin, EpiPens and drugs that save people from opioid overdoses. A Warren administration would help companies produce expensive medicines as a price-control measure and use administrative authority to ensure sufficient supply.

I’ll be touching more upon the upcoming fight to abolish or reform the filibuster but I am very happy that Barkan is on board with Warren’s plan and I support it 110%. If you support it too, click here to donate and get involved with Warren’s campaign.

  • November 20, 2019
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