Thread by @Jacob_S_Hacker

The Public Option is back in the news, along with Medicare for All. But how are they different? And which is better? Here’s my take. 1/

The Public Option, which I first advocated in 2001 (though I didn't use the term), is a Medicare-like public insurance plan that would be open to everyone -- and could evolve into Medicare for All. Here’s a piece that explains it: 2/

vox.com/policy-and-pol…

Then there's Medicare for All -- which (notwithstanding the misleading headline of the last piece) is pretty different from the Public Option because it would immediately universalize Medicare. Medicare is popular and successful, so why isn’t everyone behind Medicare for All? 3/

One big problem has always been the transition from here to there. People with good coverage don’t want to suddenly lose the health insurance they have, and people now on Medicare worry that expanding it will hurt them. Any serious proposal has to address this concern. 4/

Another big question is how to pay for it. Bernie is getting hammered in part because he hasn’t really tried. Warren sought to answer the question, as well as say how we'd get from here to there. Her answer was actually pretty good, as I argued here: 5/

nytimes.com/2019/11/05/opi…

Finally, as someone who has worked on this for a long time, what’s striking is how far the debate has come. But make no mistake -- and we have learned time and time again -- any of these plans will have a difficult time getting through Congress. 6/

Any serious reform proposal is dead in the water unless the Senate switches to Democratic hands. (Getting rid of the filibuster would help a lot, too.) So anyone who cares about reform should be thinking about congressional elections as well as the presidential one. 7/