Many dark and miserable months into the 2020 Democratic primary, the nation is still enduring the sight of the candidates having the same fights over health care, like an exhausted married couple whose quarrels will always come back to What Was Said at that party in 2008. It seems we are doomed to push the “how will you pay for it” rock up the hill forever, but we’re also seeing other attacks leveled against Sanders and Warren over and over: Why do you want to kick people off their private insurance? Don’t you trust the American people to make their own choices? Why don’t you love Obamacare? Can you actually get things done?

These attacks are leveled by candidates with plans that all fall well short of the benchmarks that Medicare for All sets for itself, in an effort to depict Medicare for All as dangerous or unrealistic. But these candidates fail to grapple with the danger and false promises of their own plans—including the big lie that by creating a public option, we can maintain private insurance (the main goal being to protect the private insurance industry’s buckraking) while also providing health care to everyone. If the primary debates are any guide, these plans—and this fatal flaw—have been deemed to be immune from scrutiny.



The public option is the phony diet option of Medicare for All, promising to have none of the calories and all of the taste. These plans pretend that everyone can keep their specific insurance plan that they like; that everyone can be covered, with no gaps in enrollment, no cracks for people to fall into; that insurance companies, drug companies, and big hospitals can be brought on board to pass legislation without compromising on universality or quality. Medicare for All, on the other hand, grabs the bull by the horns and deals directly with the issue: Private, employer-sponsored insurance is a bad way to provide health care, and no one should have it.

One of two things would happen under the public option plans put forth by Pete Buttigieg, Beto O’Rourke, or Joe Biden. One possible outcome is that the public option on offer could be robust and equitable, with good coverage, low premiums, and functionally solid mechanisms for automatic enrollment and the accurate determination of subsidies. (This is more likely under O’Rourke’s preferred Medicare for America proposal than Joe Biden’s plan, for example.) This would encourage many people to sign up, instead of sticking with their employer coverage. If this happens, private insurance could well get weaker; insurance company revenues would go down and additional costs would be passed on to patients in order to make up for the profit shortfall and maintain the plum salaries of executives. Fewer people being enrolled in private insurance might well mean insurance companies won’t have as much to offer to hospitals when negotiating prices (though they clearly already do a terrible job of that). Private insurance would die a drawn-out death, and it might not be pretty.

Do we think that UnitedHealth Group, which had profits of more than $3 billion last quarter, will go quietly?

This prospect isn’t just speculation; this is a firmly stated virtue of the plan, that the public option will be so attractive that eventually everyone is on it—what Buttigieg calls the “glide path” to Medicare for All. The idea is to defeat insurance companies at their own game, with the government providing such a darn good product that private insurance will just slink off into the shadows, because of competition and freedom. Markets, as we know, always work logically and correctly. Do we think that UnitedHealth Group, which had profits of more than $3 billion last quarter, will go quietly? More importantly, if the goal is to slowly smother private insurance, why promise that people can keep their plans that they like—plans that you intend to ultimately kill?

