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What do the Democratic candidates for president believe about Medicare for All? With the exception of Bernie Sanders, it’s hard to say. Kamala Harris has backpedaled. Cory Booker contradicts himself. Elizabeth Warren has a wavering record and avoids the subject as much as possible. Meanwhile they all support competing legislation on the side. Beto O’Rourke’s reversal is the most flagrant yet. In a mere two years the former Texas congressman has gone from vocally championing Medicare for All to bizarrely calling the single-payer policy “too ideological.” O’Rourke’s stance on health care policy has been so unclear that a Vox reporter felt the need to conduct an investigation into it. After a career of noodling around on the issue, he seems to be zeroing in on his favored approach now that he’s running for president. O’Rourke is touting a proposal called Medicare for America, a public option bill modeled off of previous work by neoliberal think tank Center for American Progress. O’Rourke claims that this bill presents a pathway to Medicare for All. In fact, it does not. O’Rourke’s Medicare for America proposal would throw a lifeline to private insurers, keeping them afloat (and raking in profits) while derailing the demand for Medicare for All that Sanders has helped make wildly popular.

Medicare for America Is Not Medicare for All It’s instructive to directly compare Medicare for All with Medicare for America. Medicare for All is a simple concept. It would establish a single, public health insurance program that guarantees free, comprehensive care to all US residents. Under Medicare for All administrative costs are drastically reduced, no doctor is out of network, and the vast majority of households will pay far less for better coverage. Medicare for America, on the other hand, is a public option proposal that would enroll some Americans in a public plan while preserving private insurance for those who receive it from their employers. Rather than covering everyone equally under a single program, it will maintain varying qualities of coverage with price tags based on income. While Sanders’s proposal eliminates financial barriers to care, Medicare for America leaves them more or less in place. Medicare for America includes premiums of up to 10 percent of a person’s annual income and out-of-pocket maximums of $5,000. In a country where four in ten people don’t have the savings to cover a $400 emergency, these costs will either prove to be financially devastating or deter people from seeking needed care. The proposal’s proponents argue that allowing Americans to opt into public insurance will gradually chip away at private insurers’ clienteles until the vast majority of Americans — or even all Americans — are covered under the same public plan. O’Rourke claims that the public option will become “the program of choice.” But by allowing private insurers to compete with the public plan, Medicare for America ensures that care will remain unequal and segregated. This is why Medicare for America is not a pathway to single payer. Its multitiered and means-tested approach will inevitably pit working people against one another. Imagine a situation in which only poor and working-class Americans utilize the public plan, while wealthier people can afford better plans. This is a breeding ground for resentment, which can be mobilized towards defunding the public option. Once that happens, patients enrolled in it will experience shrinking coverage and higher costs. This will naturally lead to the growth of private supplemental plans and leave Medicare vulnerable to further privatization with the encouragement of a still-powerful private insurance lobby. (We see this already with costly Medicare Advantage plans.) If the public plan is as good as O’Rourke suggests, why not enroll everyone in it now?