Medicare-X would start in rural areas where there is one or no insurer to increase competition and lower costs. It would then expand to every ZIP code, and become available as an option on the small business exchange. Medicare-X would also, for the first time, allow the federal government to negotiate lower drug prices on behalf of the American people. By using the existing Medicare framework, it does all of this without adding any bureaucracy.

3. Would you favor only modifications to the Affordable Care Act, including extending premium assistance to more middle-class Americans?

No.

We should build upon the Affordable Care Act, including by extending premium assistance to more middle-class Americans who are above the A.C.A. cliff of 400 percent of the Federal Poverty Level. My Medicare-X plan would do that, in addition to increasing support to families under the 400 percent threshold who are currently receiving tax credits to help pay for insurance.

But we shouldn’t stop there. Medicare-X would also provide everyone with the choice of purchasing a public option, and it would allow the federal government to negotiate lower drug prices. We also need to reduce the cost of health care by increasing transparency and modernizing how we care for people.

4. If you support more than one of the above, which of the options do you believe would be the best way to improve the health care system?

Public option.

If you went into a living room anywhere in the country and told everyone about Medicare-X, my plan to create a true public option, I believe it’s a plan they could get behind. We don’t need to blow up our current health care system to provide everyone with high-quality, affordable care. And we don’t need to take insurance away from people who receive it through their employer and like it. Medicare-X starts in rural areas where the market is failing too many people. It covers essential health benefits and uses Medicare’s network of doctors and providers. It allows the federal government to negotiate lower drug prices. And it does all of this without creating any new bureaucracy.

5. Should all Americans be required to carry health insurance?

Yes.

All Americans should be covered by high-quality, affordable health insurance. For people who are already eligible for Medicaid and other programs, our default should be for those programs to cover them. States that have yet to take advantage of the Medicaid expansion in Obamacare should do so in the best interests of their residents. Ultimately, by offering a strong public option through Medicare-X, we can accomplish universal coverage.

6. Do you think health insurance should be financed completely by taxes, or through a combination of taxes, co-payments and premiums?

My Medicare-X plan would save taxpayer dollars relative to the current health care system, even as it covers millions more people. For example, a more modest public option has previously been projected by the nonpartisan, independent Congressional Budget Office to save $158 billion for taxpayers over a decade (source: bit.ly/2MH8b1V). That’s because a public option like Medicare-X requires premiums, but also cuts health care costs relative to private health insurance. We would then take those savings and reinvest them in improving upon Obamacare, so that more middle-class Americans are able to afford health insurance.

Notably, this differs dramatically from Medicare for All, which the nonpartisan Urban Institute has suggested would cost more than $32 trillion over the next 10 years (source: urbn.is/2WEIH9H). Regardless of whether people think this is the right approach, we have to acknowledge that nobody has shown how they would specifically pay for even a significant fraction of this total cost. According to Vox, when single-payer failed in Senator Sanders’s home state of Vermont, it failed when taxpayers were confronted with the fact that it would necessitate an increase in payroll taxes of 11.5 percent and income taxes by 9 percent (source: bit.ly/2VCeMOW).