Elizabeth Warren's critics say Medicare-for-All is unrealistic. She just detailed how she'd do it

Elizabeth Warren in a black jacket with the American flag in the background
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On Friday, Massachusetts Sen. Elizabeth Warren released her long-awaited plan that explains how she would transition the country to a Medicare-for-All, single-payer health care system as president. To achieve this goal of Medicare-for-All — a position she and fellow 2020 hopeful Vermont Sen. Bernie Sanders have maintained despite attacks from more moderate opponents — Warren said she would transform the current American health care system in two phases during her first term. Warren’s plan would involve gradually introducing the government-run system, first by immediately implementing a public option, and then by working in her third year to fully pass the Medicare-for-All framework, which would provide single-payer insurance to every American.

The first phase would see Warren using the Senate budget reconciliation process, which allows bills with specific scopes to bypass the Senate's 60-vote threshold and instead be passed with a simple majority. Interestingly, this is the same tool Republicans attempted to use to repeal Obamacare in 2017, though they ultimately still failed to get enough votes in the Senate. Through this process, Warren would attempt to pass legislation that would immediately give Medicare-for-All benefits for free to children under 18, and to families making exactly or less than 200% of the poverty level. She said in her plan that number would be about $51,000 for a family of four.

During this first phase of Warren’s plan, there would essentially be a “Medicare For All Who Want It” system in place, where any American not covered by the above stipulations could buy into Medicare coverage. This phase would look vaguely similar to the plans being championed by more moderate Democratic candidates like Mayor Pete Buttigieg of South Bend, Indiana, and Vice President Joe Biden, though the benefits under Warren’s phase would be more robust than their proposals and available to more people for free. Though during this first segment, most Americans seeking this coverage would have to actively buy into the plan, their health care costs would go down over time as the government transitions to a full Medicare-for-All System, Warren argued. In this first phase, she also would lower the Medicare eligibility age from 65 to 50.

The ultimate difference between Warren and her more moderate opponents is that this public option system is just the first step for her vision, not the end goal. During the second phase, she would advocate for Sanders's full Medicare-for-All single-payer system and completely abolish the private insurance industry.

So, though her path is different from Sanders's — he would immediately put everyone above 55 and below 18 on Medicare, allow others to buy in, and then expand those automatic windows of enrollment over the next few years until everyone is covered after four years — Warren still aims to achieve universal, government-run coverage by the end of her first term as president. She explained in her Medium post that she believes her two-phase system is the best way to get there.

"Given the quality of the public alternatives, millions are likely to move out of private insurance as quickly as possible," Warren wrote. "No later than my third year in office, at which point the number of individuals voluntarily remaining in private insurance would likely be quite low, I will fight to pass legislation to complete the transition to the Medicare-for-All system defined by the Medicare-for-All Act by the end of my first term in office."

In October’s debate, Warren was fiercely attacked by opponents like Buttigieg and Minnesota Sen. Amy Klobuchar, who accused her of not providing enough details about how she would pay for or actually implement a Medicare-for-All system. With the November debate happening next week, and the Iowa caucuses less than 100 days away, Warren appears to be setting herself up to proactively defend herself from critics as the presidential campaign kicks into high gear.

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Despite that, this plan will still be open to criticism from Republicans and Democrats alike. Left-leaning critics might view Warren's two-step approach as a way to merely implement a public option while being able to say in public that you want Medicare-for-All, while more moderate and conservative critics can still argue that this plan is government overreach or an unrealistic pipedream. There also remain the uncertain logistics: Passing the bill would still require not just a Democratic Senate majority, but a Democratic Senate majority willing to fight for universal health care.

Proponents of Warren's plan, though, could argue that it’s a smart way to thread the needle. There's a major ideological divide within the Democratic party on health care, and her two-phase strategy may be able to capitalize on the popularity of the public option and use it as a pragmatic pathway to reaching universal coverage within her first term.

Notably, Warren also detailed in her plan how she'd proceed under a less-than-ideal reality: if she became president but Republicans maintained control of the Senate. While there would be no immediate hope for Medicare-for-All in that case — or even Medicare For All Who Want It — Warren’s plan should Democrats not retake the Senate includes executive actions she'd take within her first 100 days.

“I’ll use the tools of the presidency to start improving coverage and lowering costs — immediately,” she wrote. “I’ll reverse Donald Trump’s sabotage of health care, protect individuals with pre-existing conditions, take on the big pharmaceutical companies to lower costs of key drugs for millions of Americans, and improve the Affordable Care Act, Medicare, and Medicaid.”

Warren’s transition plan will face the ultimate test at next week’s debate — the first chance her opponents will have to attack her on the details of her ambitious health care goals. Whether she'll be able to effectively defend her ideas to real-time scrutiny from her opponents and establish her message as the winning one remains to be seen.