The plan Elizabeth Warren released this week for Social Security is as smart, detailed, and all-encompassing as you could ask for. She also released a plan on health care reform ahead of Thursday's debate. Unfortunately, it doesn’t have the same attributes that her Social Security plan does.
She supports Medicare for All as "the best way to give every single person in this country a guarantee of high-quality health care. Everybody is covered. Nobody goes broke because of a medical bill. No more fighting with insurance companies." But there are areas of real ambiguity on how extensive her Medicare for All plan would be, and where things like prescription drugs, mental health care, long-term care, dental and vision and hearing care, or reproductive health care would come in. These things are either missing or problematic.
Starting with prescription drugs, Warren's campaign points to her Affordable Drug Manufacturing Act, introduced last year. It's a smart bill, but a smart bill for the existing health system and not necessarily for a new one created under Medicare for All. Under it, "HHS would manufacture generic drugs in cases in which no company is manufacturing a drug, when only one or two companies manufacture a drug and its price has spiked, when the drug is in shortage, or when a medicine listed as essential by the World Health Organization faces limited competition and high prices." That would bring prices down, but the out-of-pocket cost for consumers isn't addressed in this proposal. Warren has other legislation called the Capping Prescription Costs Act, which again operates in the existing system but sets out-of-pocket caps at $250/month for individuals and $500/month for families. It's not clear whether Warren envisions this as part of a Medicare for All law she would champion. But $6,000 annually for families as a cap is still very high.
On mental health, she again points to existing legislation, the Behavioral Health Coverage Transparency Act, which "would hold insurers accountable for providing adequate mental health benefits and ensure Americans receive the protections they are guaranteed by law." That suggests that mental health care would be provided by private insurers instead of publicly, through a single-payer system.
The campaign also points out that she has "worked to hold the Department of Health and Human Services accountable for improving insurers’ compliance with mental health parity laws through an online consumer portal.” Again, these are the things she's doing within the existing system, and not forward-looking to how it could work under Medicare for All.
The campaign also points up her new CARE Act with Rep. Elijah Cummings, which "would invest $100 billion in federal funding over the next ten years in states and communities to fight" the opioid epidemic. It's, again, very good legislation, but feels slightly shoehorned into this campaign statement, which doesn't actually rise to the level of plan set by Warren herself in all her other plans. It does include a new plan to help rural hospitals, creating "a new Medicare designation for rural hospitals that reimburses them at a higher rate and offers flexibility of services to meet the needs of their communities." But not included at all are long-term care, or dental and vision and hearing care.
It seems that Warren hasn't spent the time and care envisioning a Medicare for All kind of program at the same level of detail that she has for every other plan. This reads like a cobbled-together rough draft, cribbing from her (very smart) already completed homework. But those already done bills, smart as they are, don't add up to a plan and wouldn't fit easily into a Medicare for All system like the ones introduced by Bernie Sanders or Washington Democratic Rep. Pramila Jayapal, who has the gold-standard legislation.
For Warren, who has set a very high bar for herself, this is shoddy work. The issue deserves more attention and more coherence from her. The "how do you pay for it" answer will have to be laid out, too, but for the moment a focus on "what" is going to be paid for has to be more clear.
