Why this M4A supporter is voting for Biden

There is no doubt that Biden does not support Bernie Sanders’ “Medicare For All” plan. It is a specific bill, introduced into Congress, by Bernie Sanders that establishes the US federal government as the one and only medical insurance company for all Americans. Similar to the systems of Northern Europe and Canada, Medicare for All is a plan that is efficient and it covers everyone. So why doesn’t Joe support it? I certainly do.

Let’s be clear about something. We are discussing four different visions of healthcare here. Let’s put it on a Venn Diagram. You will see, clockwise from the upper right, the Republican Plan, Obamacare, Biden’s plan, and Medicare for all.

venn diagram showing different healthcare plans
Venn Diagram of healthcare payment options

There is a raging debate online that goes like this: if you are a supporter of Medicare for All, you cannot possibly support Joe Biden. He’s not getting us there. He’s as bad as Trump and the Republicans. Those folks like to take the Venn diagram above and reduce it to the “private insurance only” bubble, which looks like this:

Venn diagram with only the private insurance options

See, the pundits exclaim! It’s all private insurance, and private insurance is bad, so supporting Joe Biden is bad.

My retort is simple. Two can play that game. Let’s reduce the venn diagram the other way, to show all the government plans:

Venn diagram showing all the government options: Medicare for All and Biden's Public Option
Venn Diagram showing only the government options

Now, let’s consider this: Biden’s plan is closer to Medicare for All than we have ever had in this country. It is a move in the right direction.

The ACA-with-public-option allows individuals and businesses to buy in to Medicare/Medicaid if they want it. (It’s essentially identical to Pete Buttegieg’s “Medicare for all who want it” plan). Or they can buy into private insurance if they want it. Either way. It allows people to buy government run healthcare, something that simply is not available today. Something the Republicans deathly oppose. Biden will also subsidize the poor to buy any ACA plan, including Medicare/Medicaid.

Why is this a good approach? Because if we allow people to buy in to Medicare, the market does the rest. We end up with Medicare for all, but we do it without the immediate pain of killing private insurance. Private Insurance* dies all by itself. (Which is why the Republican’s hate it. They are getting lots of cash from those companies).

How does the private option kill private insurance? Competition.

Medicare/Medicaid is wildly efficient. It is far and away the most efficient healthcare available in the US. What’s the number two most efficient healthcare system in the US? The Veterans Administration. In other words, if you want efficient inexpensive healthcare, government healthcare plans are the best and the least expensive.

Now imagine your employer offers you four health plans to choose from. One is a very sweet Blue Cross plan that costs a fortune, another is a high-deductible plan from Aetna that costs less but you have to cover the first $5000 of medical expenses every year, a third is an inexpensive plan aimed mostly at young and healthy people that doesn’t cover a lot of things. The fourth is Medicare/Medicaid. Which are you going to choose?

Medicare/Medicaid is much less expensive than the others, includes pregnancy care, prenatal care, pediatrics, preventative health, hospitals, most medications, cancer, diabetes, heart disease, surgery, etc. The list goes on and on. And it’s the least expensive option on the list. It’s even less expensive than the small plan aimed at young people.

Which are you going to choose? Millions of Americans will choose to put the extra few dollars into their pocket and will buy in to Medicare/Medicaid. Once 50 million or so people switch, which will happen in about three years, half the insurance companies in America will go bankrupt. People will have extra cash in their pockets and most of the remaining insurance companies will be switching to offering Medicare Advantage plans (a much less lucrative, and less extensive, business).

Now, after this transition, you have millions of people who are happily getting medical bills paid for by Medicare/Medicaid. Subsidies cover 100% of the much lower premiums for the poor.

Now comes the kicker. The CMS (the government insurance company) can negotiate for lower drug prices. As the largest insurer in the country, they will have tremendous clout. Drug prices become lower for people who buy Medicare than people who buy private insurance. Premiums for Medicare/Medicaid drop even further by comparison. Employees switch in huge numbers. The rest of the market consolidates. There is now only one private insurance company offering basic care and the other company is the government offering Medicare.

That private company goes out of the primary care business, switching over to offering Medicare Advantage medical insurance. At that point, we have Medicare for All.

All by voting for Joe Biden.

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