Elizabeth Warren's pragmatic approach to Medicare for All may not be very practical

by Axios | 11.18.19

This piece was authored by Axios, and its content solely reflects the published views of Axios and its journalists.

Sen. Elizabeth Warren's two-part plan to pass a public option as a transition into Medicare for All — and then full-blown Medicare for All a few years later — has revealed the difficulty of appealing to both the pragmatic and progressive wings of the party.

The big picture: Warren's already being criticized by progressives for not being a Medicare for All purist, and because of the realities of governing, they may have a point: Passing two major health reforms in one term is unheard of.

Details: Warren's transition plan — which she said she'll try to pass within her first 100 days in office — would allow anyone over 50 to enroll in an "improved Medicare program," and "every person in America" could get coverage through a "Medicare for All option."

• Coverage under the public option would immediately be free for children under 18 and families making 200% of the federal poverty level or less. Over time, it'd become free for everyone.
• Then, by no later than her third year in office, Warren would push Congress to pass full-blown Medicare for All.

Reality check: The political capital that it'd take to pass Warren's public option, even through a special procedure called "budget reconciliation" that'd allow her to bypass GOP opposition, would be enormous.

• And Medicare for All supporters weren't enamored with the more incremental approach. "In my first week as president, we will introduce Medicare for All legislation," Sen. Bernie Sanders tweeted on Friday.

What they're saying: "Passing one major piece of health care legislation with a knock down, drag out fight, followed by another one three years later, sounds pretty difficult," said the Kaiser Family Foundation's Larry Levitt.

• "A more likely scenario is that a public option would pass, and be given time to work. Depending on how that debate went, Medicare for [A]ll could be a rallying cry for a reelection campaign."

The bottom line: Warren's "transition" plan — which also includes a long list of actions she'll take to protect the Affordable Care Act, aggressively enforce antitrust laws, end surprise medical bills and lower prescription drug prices — also works as a standalone health care plan. Whether that's a good thing or a bad thing depends on who you ask.