Rejoice, Democratic lovers of Plans, for your presidential field’s second-string wonk candidate Pete Buttigieg has produced details for his health care plan. (To be fair, this is more than can be said for the field’s starting wonk, Elizabeth Warren.) Despite his carefully cultivated image as a master squarer-of-circles—the only man on Earth to have surmised that policies should be based on evidence—his Medicare for All Who Want It plan is deeply stupid. It betrays a terminal case of Democrat Brain; it is a faux-technocratic fantasia soaked in the utterly meaningless jargon of Access and Affordability that won’t even accomplish the things it pretends to want. It is an insult.

These health care plans that rely heavily on the theory of a cure-all “public option” are all designed for the same purpose: Giving candidates space to convincingly claim they would provide universal coverage (or, if not coverage, at least universal “access”) while also preserving the role of private, employer-sponsored insurance. They exist to be an alternative to Medicare for All that successfully convinces voters, the media, and donors that universal health care is possible without all of the scary socialism.



As such, these plans strive to please the people who are currently served reasonably well by our current health care system, or who the Democrats think would be more afraid of change: people with good employer-sponsored plans, or people who are not chronically ill and don’t have much direct experience of how bad the system is. (More importantly, it’s people who are reasonably wealthy, whose votes Democrats are quite concerned about keeping.) Along the way, such plans allow those that propose them to lay claim to better prospects of passing a hostile, GOP-controlled Senate (which is naïve) while not engendering a wider war with any number of deep-pocketed health care industry pressure groups (which is also naïve).

But any plan must attempt to contend with the most appalling and gaping sore on America’s health care system: the 27 million people who lack insurance. Buttigieg’s plan claims it would “automatically” enroll the uninsured. First, “individuals with lower incomes in states that have refused to expand Medicaid will be automatically enrolled in the public option.” Joe Biden’s plan has a similar proposal, to essentially go around state governments that didn’t expand Medicaid by providing a subsidized public option that would mimic expanded Medicaid. (Somewhere in Washington, Samuel Alito’s loins are twitching.)



With very little detail as to how it would be brought about, Buttigieg also asserts that his plan would automatically enroll anyone “eligible for free coverage in Medicaid or the public option.” Here, the South Bend mayor targets a narrow population that is getting screwed over by the last big patchwork health care reform attempt: people who make too little to qualify for Affordable Care Act subsidies, but don’t qualify for Medicaid in states that did not expand Medicaid availability to the benefit of those who make less than 138 percent of the poverty line.

