Yesterday, Rolling Stone published an interview with Nancy Pelosi in which she was asked about Medicare for All. Her answers were bad. A Hill article highlighted one of her worst lines, in which she wondered “how do you pay for” single-payer. This makes no sense. The United States already spends almost twice what other countries do as a proportion of their GDP on healthcare; we are already paying for it, dearly. Single-payer wouldn’t make healthcare more expensive, it would just change how it’s paid for. Instead of paying premiums, you’d pay a bit more in taxes (depending on your income), and providers would save a lot of money on administrative costs by not having to deal with and bill hundreds of separate insurance plans.
But the worst part of the Rolling Stone article is even more troubling than Pelosi trotting out Republican talking points to criticize a policy she claims she’s supported (of the activists who conducted sit-ins in her office, she told the magazine, “I was carrying single-payer signs before you were born.”) The worst is where she either reveals she has absolutely no idea what’s in the Medicare for All bill introduced this week by Rep. Pramila Jayapal or just straight-up lies about it in order to criticize Medicare for All:
When they say Medicare for All, people have to understand this: Medicare for All is not as good a benefit as the Affordable Care Act. It doesn’t have catastrophic [coverage] — you have to go buy it. It doesn’t have dental. It’s not as good as the plans that you can buy under the Affordable Care Act. So I say to them, come in with your ideas, but understand that we’re either gonna have to improve Medicare — for all, including seniors — or else people are not gonna get what they think they’re gonna get. And by the way, how’s it gonna be paid for?
Now, single-payer is a different thing. People use the terms interchangeably. Sometimes it could be the same thing, but it’s not always. Single-payer is just about who pays. It’s not about what the benefits are. That is, administratively, the simplest thing to do, but to convert to it? Thirty trillion dollars. Now, how do you pay for that?
Let’s be clear: This description bears absolutely no resemblance to either Jayapal and Bernie Sanders’ Medicare for All bills, nor any kind of Medicare for All that’s being pushed by advocates like the National Nurses United. (We’ve reached out to both Pelosi and Jayapal’s offices for comment and will update if we hear back.)
She says it wouldn’t be “as good a benefit” as plans under the Affordable Care Act. That’s wrong. It would cover “would cover hospital visits, primary care, medical devices, lab services, maternity care, and prescription drugs, as well as vision and dental benefits,” plus abortions, according to Vox. Affordable Care Act plans do not include dental or vision, nor do they offer plans without copays, deductibles, or charges for prescription drugs. Also, they are expensive and garbage.
She says “It doesn’t have catastrophic [coverage]—you have to go buy it.” This has zero relationship to reality. No one would have to buy any coverage under Medicare for All; everyone would be covered.
She says it doesn’t have dental—again, it does.
She says, “We’re either gonna have to improve Medicare—for all, including seniors—or else people are not gonna get what they think they’re gonna get.” But that’s exactly what these bills would do—improve Medicare for everyone, including seniors. So it seems like people would indeed get what they think they’re going to get.
The interesting part comes where she distinguishes between Medicare for All and single-payer. She says, “It could be the same thing, but it’s not always.” But the Medicare for All plan that was introduced in the House and is cosponsored by more than 106 members of her caucus is a single-payer plan. And she seems to get it very wrong again when she says single-payer is “not about what the benefits are.” I guess that’s true in that single-payer is a technical term describing any system in which the government is the only payer, but—and I’m sorry to repeat myself but this is where we are—the major Medicare for All bills do define the benefits, and they are generous.
What she seems to be describing is a plan to simply expand the current Medicare program, with all its current limitations, to all Americans; that explains comments like “it doesn’t have dental” and “you have to go buy” catastrophic coverage, which is true for seniors under the current version of Medicare, at least for drugs. But that’s a total straw man. Neither Jayapal, nor Sanders, nor any other advocates in the House or Senate or on the presidential stage, are interested in that; indeed, the title of Jayapal’s bill says it would establish an “improved” Medicare for All. It’s in the name.
So the question is: Is Nancy Pelosi stupid, and has somehow managed to avoid finding out this incredibly important fact about Medicare for All? Or is she lying to intentionally disparage Medicare for All—perhaps to give cover for the louder critics in her caucus who oppose the bill, or perhaps because she really just genuinely does not want to see Medicare for All become law? Perhaps because her top health aide promised health insurance executives that Democratic leadership “would be allies to the insurance industry in the fight against single-payer healthcare?”
(On that note: Just this morning, the Partnership for America’s Health Care Future, a massive and well-funded lobbying group formed by the healthcare industry to fight Medicare for All, sent out an email blast highlighting Pelosi’s false claims as “skepticism” in Congress over the new bill.)
So is Nancy Pelosi merely an accidental pawn of the healthcare industry—the health insurance and pharmaceutical companies that profit so handsomely off our current system—or is she their willing ally?
All evidence indicates Nancy Pelosi is a very sharp woman; I’d be shocked if no one had told her what Medicare for All actually is, or if she just plum forgot. If she’s lying on purpose, and is actively trying to mislead the public about what Medicare for All is in the run-up to a 2020 campaign where this issue will take center stage, you have to wonder—why go that far? If she wanted to help her conservative members throw a wrench in the Medicare for All works, she could easily do that without such brazen lying. Hell, it’s not like the incredibly powerful insurance and pharmaceutical industries are going to need much help to do that themselves. So what’s in it for her?