Minnesota Sen. Amy Klobuchar ramped up her new presidential campaign Monday with a CNN town hall appearance, during which she was of course asked about Medicare for all. Her answer was pretty much what one would expect, given that she’s branding herself as the practical moderate.
Lefty Twitter was, predictably, displeased. (There was a lot of “thank u, next,” which has become a stock tweet from very online socialists whenever a candidate fails to back full-on single-payer.) But even if you didn’t particularly like the substance of Klobuchar’s response, I think she deserves credit for being forthright; Democrats would be better off if more candidates talked about health care with her level of candor.
After a bit of throat clearing about how many Americans still can’t afford health coverage or care, Klobuchar explained that her immediate goal was to build on Obamacare by creating a public insurance option. She even had a specific bill in mind—Sen. Brian Schatz’s Medicaid buy-in, which she has co-sponsored.
What we need is to expand coverage so people can have a choice for a public option. And that’s a start. And you can do it with Medicare. You can do it many ways. But you can also do it with Medicaid, something I don’t think we’re talking about enough as a potential solution. This is a bill that I am one of the original sponsors of, Sen. Sanders is also sponsoring it, it’s a bill by Brian Schatz, who is a senator from the state of Hawaii, and what it basically says is “Let’s expand Medicaid so you can buy into Medicaid, and it’ll bring the prices down, and we can cover more people.”
Schatz’s bill is an interesting, slightly sideways approach to health care reform that has both advantages and disadvantages compared with versions that focus on Medicare. I wrote a longer piece about the legislation back in 2017, when its outline started circulating. While a few details have changed since, the gist is basically the same. It would allow states to create public health insurance plans through Medicaid, with premiums capped at 9.5 percent of a family’s income. The policies could be sold on Obamacare’s exchanges and states would be free to include copays and deductibles. In states that adopted it, residents would be guaranteed access to health insurance priced at no more than one-tenth of their income; that’s progress from today’s status quo, where families that earn more than 400 percent of the poverty line have to pay the full cost of insurance, no matter how high premiums rise, and counties can be left without coverage options if private insurers decide to bail. It would also make Medicaid payments to primary care doctors more generous, which could encourage more physicians to accept it. And by working through Medicaid, it avoids the usual Republican attack that Democrats are somehow going to destroy Medicare by expanding it.
There is also a big, obvious drawback to the plan: Just as they’ve resisted Obamacare’s Medicaid expansion, a lot of red states might reject Schatzcare and refuse to create a buy-in program. If you really want to build a public option, it may be simpler and more effective to create a federal program.
But even if I don’t love Klobuchar’s policy instincts on this issue, I do appreciate that she bothered to explain what specific direction she would push health care reform in as president. Almost every candidate has been asked whether they support Medicare for all. But almost none of them, with the exception of unofficial contender Sen. Sherrod Brown, have explained, in detail, what their fallback plan is if it becomes clear that a Sanders-style single-payer bill, or something almost as ambitious, can’t pass Congress—which, between the filibuster, the 2020 Senate map, and the fact that whatever makes it through Capitol Hill will probably need to earn Sen. Joe Manchin’s vote, seems to be the likeliest scenario. (I’m not saying I think single-payer could never pass; I’m saying I’d bet a lot of money on PredictIt against it happening in the next 12 years). That’s unfortunate, because there are big differences between the various not-quite–Medicare for all plans floating around Congress. It’s relevant if a candidate thinks that a quarter-measure like a Medicare buy-in for 50-year-olds is good enough, or if she wants to avoid a fight over Medicare by using Medicaid to expand coverage. There’s a savvy-guy, cynical take that it doesn’t really matter all that much what legislation candidates back, because the chances of anything passing at all are so slim, and the Senate will have an outsize voice in the shape of specific policies. But I think just the opposite seems true: It’s important to know where a White House hopeful’s policy preferences actually lie, because in a close vote, whether or not something can actually become law may depend on a president’s willingness to spend political capital getting it over the finish line.
Klobuchar might be aiming a bit low on health care, as far as some Democrats are concerned. But they should give her credit: At least she’s telling them enough to know where she stands.
