Monday, September 23, 2019

Elizabeth Warren's healthcare toggle switch: A two-year review

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An hour ago I stumbled on a two year old post teasing out Elizabeth Warren's ambivalence about Bernie Sanders' Medicare for All bill, as expressed on the occasion of her co-sponsoring it. That's led me to reflect on the apparent cross-currents in Warren's mind drawing her alternately toward and away from fast-track hard-core single payer.

Here are some longstanding key points in Warren's healthcare stance, fleshed out in the links provided at bottom.

1. Warren's entire political outlook and diagnosis of the U.S.'s economic and political woes is founded on her understanding of the impact of medical debt and other costs of illness (e.g., lost wages) on ordinary Americans.

2. Warren's outrage against banks and other financial institutions that she views as helping Americans "drown in debt,"  taken up several notches in the wake of the 2008 financial crisis, transfers easily to outrage against health insurers -- which are, after all, financial institutions of a sort.

3. Warren has consistently, one-dimensionally, focused all her outrage about the huge medical costs foisted on millions of Americans on health insurers and pharma -- the traditional targets -- while giving predatory healthcare providers a pass (as have virtually all her peers, with the recent exception of Pete Buttigieg).

4. Notwithstanding that outrage, Warren's own healthcare reform bill and proposals prior to kicking off her presidential campaign would be quite palatable to insurers. In brief, she would require insurers to provide more comprehensive coverage while boosting federal subsidies to make that better coverage affordable to enrollees (and profitable for insurers).

4. For two years, Warren has expressed support for Sanders' Medicare for All bills -- while betraying ambivalence about Sanders' sweeping, tear-it-all-down approach.  That ambivalence has most often been expressed in statements to the effect that there are multiple paths to universal coverage -- see, e.g., the Sept. 2017 post that's my starting point here; Warren's all-Medicare-buy-ins-are-good riff in a March CNN town hall, discussed by Charles Gaba here; and Warren's New York Times interview, published shortly before the June 26 CNN debate.  That "alternative paths" back-beat has gotten fainter since the CNN debate, in which Warren declared "I'm with Bernie on Medicare for All," but it hasn't disappeared entirely.

Here are posts tracing this winding path:

Elizabeth Warren is for single payer, sort of. And against healthcare profiteering...sort of  (9/11/17)
Warren was in favor of putting Bernie's bill on the table - not necessarily passing it.

Elizabeth Warren is faking it on healthcare (1/26/18)
In a speech at the annual Families USA conference, Warren presented the unaffordability of healthcare in the U.S. as purely a product of insurance industry rapine.

Elizabeth Warren roars at health insurers, but her ACA 2.0 offers them a pretty sweet deal (3/22/18)
Warren introduced a bill that would sharply increase ACA premium subsidies and tighten rules on insurers.

Elizabeth Warren is faking it on healthcare, part 2 (6/27/19)
Reflections on the CNN debate, in which Warren went all-in for BernieCare.

1 comment:

  1. I like Warren on health care precisely because of her pragmatic, next-step programs to improve the ACA and increase insurance you say, "to require insurers to provide more comprehensive coverage while boosting federal subsidies to make that better coverage affordable to enrollees."

    People often have medical debt because they have crummy insurance. They have crummy insurance because it is all they can afford. If a larger ACA subsidy helps them buy good insurance, for heaven's sake let's do it.

    Here are some key reforms:

    1. emergency care is not subject to the plan deductible
    2. Drugs have a separate, lower deductible vs. the plan as a whole
    3. balance billing would be illegal without informed financial consent
    4. all spending in or out of network would count toward the out of pocket maximums. In fact, premiums would count toward the out of pocket maximums.

    Like all insurance improvements, these steps would cause premiums to be higher. This is inevitable because insurers would be paying more in claims.

    Thus the need for more subsidies. Whether the subsidies go to the insureds or to the carriers does not seem important to me.

    It is true that wiping out all cost sharing in a Sanders-like plan would also wipe out medical debt. But if you believe as I do that a Sanders plan is unachievable legislatively, then the gradualist approach will help more people and much sooner.