 In August, during a post-debate interview, Tulsi Gabbard said something about health care reform, namely Medicare for All, that had me deeply concerned to say the least because it seemed like she was implying that her version of health care reform would include some type of role for private insurance, you know, a private option if you will. Now let me be clear, if there is a private option or public option, that is not the same thing as single payer. So this is what she said in that interview followed by my remarks about her comment. So let's do our job, try to bring down the cost of health care in this country that's exorbitant, make sure people can get the quality care they need and if they still choose that that's not what they want, they can go get the private insurance. Okay, so let me be clear. In no way do I think that was anywhere near as bad as Warren's there are many paths to Medicare for All line, but it still was deeply, deeply disappointing because Tulsi Gabbard was one of two candidates who I really felt like they hadn't wavered on Medicare for All and I don't know that she's wavering here. I think that really we need more clarification. But what she said there absolutely worried me because I want someone who's going to get in there and just crack skulls and make these private insurance companies deathly afraid. But that's not what we got there. Fast forward to today and we got the clarification that we wanted and it's not good quite frankly. If she got her way, her version of health care reform would in fact preserve a role for private insurance. How large of a role? I'm not sure, but when you say something to the effect of we need a private option that tells me that there probably won't be a duplicative ban that maybe these private health insurance companies can in fact cover essential care needs that Medicare also covers. So you get to choose if you will, you have the choice to choose between private and public insurance. And her comment, the clarification that we were looking for came in an interview with NPR. When you say health care, are you for Medicare for All? If you can just tick through the list more specifically. Yes, I support, I prefer to call it Medicare choice where we are ensuring quality health care for all people regardless of how little they may have in their pocket or their bank account while maintaining their freedom of choice. If they've got an employer sponsored plan or a union sponsored plan that they're happy with, they should have the opportunity to do so. But the bottom line being that in the wealthiest nation in the world, there is no excuse that we still have far too many Americans who are underinsured or uninsured and who are one health care emergency away from total financial disaster. That's not Medicare for All, that's not single payer. That sounds more like a public option. Now, what she's essentially saying is look, rather than eliminating private insurance, we want to give people the choice you can choose to just remain on Medicare or you can buy your own private health insurance. So that's what she wants. But let me ask you this. How is that any different than John Delaney, Kamala Harris, and what Pete Buttigieg is proposing? Because this is the same thing that they say. I mean, the rhetoric is virtually identical. Case in point. I'm Pete Buttigieg. Providing every single American with quality health insurance isn't just my plan, it's our cause. Now, I go about it in a very different way than many of my competitors. First, my plan gives everybody access to Medicare, everybody. But if you're happy with the private insurance you've got, my plan would let you stick with it if you want. Now, others say it's Medicare for All or nothing. I approve this message to say the choice should be yours. Ask yourself this. How is that different than Tulsi Gabbard's plan? It sounds like a public option. It's definitely not single payer. But if you ask Tulsi Gabbard or ask her husband on Twitter, anyways, they'll tell you, no, actually, she hasn't changed her position. She still supports Medicare for All and she definitely doesn't support a public option. In fact, he assures us that nothing has changed. She supports Medicare for All across the board with a private, not public option if people wanted. This has always been her stance. You can agree or disagree with this, but saying she doesn't support Medicare for All just isn't true. Except that is factually incorrect. Medicare for All is single payer. That's it. That's the policy as AOC put it. So if you have a quote unquote private option, that is not the same as a single payer system. Because once you introduce additional pagers into the fold, AKA private insurance companies, you are then dealing with multiple payers. Hospitals are not just billing one entity. Now they're having to bill multiple entities, the US government and private health insurance companies, which increases the amount of paperwork and leads to additional administrative costs. Simply put, that's not what single payer is and that's not Medicare for All. And what frustrates me is that Tulsi Gabbard has adopted the rhetoric of someone like Pete Buttigieg, where she's saying, no, no, no, by having this private option, I'm actually increasing choice because rather than just having everyone automatically be enrolled on this government program and there's no opt in, if they want to, if they're not satisfied with the comprehensive benefits offered by Medicare for All, they can go buy private insurance from Edna. Except the problem with this is under the guise of increasing choice in practice, a policy like this will actually facilitate less choices. Now, how is that going to be the case? Well, picture this under single payer. If I wanted to see a doctor in Portland, John Smith, I know that I would just have to call and make an appointment with John Smith. Although if we have a multi-payer system, if there's a private option introduced, well, then it's not going to be so easy. Maybe I call John Smith and I say, Dr. Smith, I want to set up an appointment with you. When are you available? Well, maybe John Smith says, actually, Michael, we only accept private insurance. Well, then that's reducing my choice as an American. I can't just see the doctor that I want to see. I have to have private insurance to see that doctor, because if we have a single payer system, hospitals and doctors, they have no choice. They have to accept everyone because we're all on the same plan. But if you introduce private, a private option, if you will, into the mix, well, then maybe some hospitals or doctor's offices will only accept private or maybe they accept both. But people who are rich purchase a private plan where it allows them to jump to the front of the line. You see, as an American citizen, where I want my choices maximized is when it comes to choosing my hospitals and choosing my doctors. But if you don't ban duplicative care and you allow these private health insurance companies to essentially handle all care, including essential care and we're not just talking about supplemental. We're talking about essential, which seems like that's what she wants. Well, then we are effectively reducing choice because that gives some doctors the option of only accepting private, some the option of accepting public, maybe some with a combination of both. But the problem with the system is that it's a multi payer system. It undercuts the benefits of a single payer system where, you know, there's no prospect of a two tiered health care system where there's different health standards for the rich and different health standards for the poor. We're also all in one risk pool under a single payer system, which reduces overall costs and it's just better overall. So by saying you support Medicare choice, well, we're only ostensibly having more choices. But in actuality, we'll have less choices because once you start introducing multiple payers, that's not single payer. So by saying that she supports choice, if she truly her goal is to support choice, then Tulsi Gabbard should support a single payer Medicare for all system with no private option because then it's just easier. I don't have to worry if John Smith, Dr. John Smith is going to say, no, Mike, we don't accept Medicare. We only accept at non private. I don't have to worry about that. I have more choice. So if choice is what you care about, this is antithetical to your goal of maximizing choice when it comes to health care. And also on top of that, we already have a private option or at least we allow supplemental because in current Medicare, there is a duplicative ban with that being said. There's a bunch of loopholes in our current Medicare system and they have been lobbying government to not close those loopholes because they don't want our current Medicare system to be comprehensive. Why? Because they want to hot these supplemental plans and sell these plans to people who already have Medicare because they want a profit. So even under Tulsi system, what I described really was a best case scenario at worse, you know, everyone who's on a public plan would be forced into some type of supplemental plan that is, you know, sold by these private health insurance companies. We'd have to buy supplemental because, again, when you start getting into the territory where you are preserving a role for private companies to offer insurance, they're going to start lobbying the government to water down the public plan because maybe they don't just want to be an alternative. Maybe they want to serve people on Medicare as well. And it's just a mess. Why would you want to do this by preserving a role for private health insurance companies? These are all the things that you're opening the door to. Now, here's the thing. Tulsi Gabbard, there's no way she doesn't know this. She knows this, right? But she's being disingenuous by saying, I am expanding choice because what her plan would look like in practice based on what she said would not increase choice. You want to get the profit motive out. You want to get the private insurance companies out of health care because if you don't, then you open the door to a less robust, more skinny version of single payer or a public option or private option or whatever you want to call it. But here's the thing. If your goal is truly the delivery of health care, then we don't need private insurance companies. We don't need them for duplicative care. We don't need them covering essential care, and we also don't need them for supplemental care because any role that you preserve for private insurance companies will in order to preserve any type of role, you have to water down the public plan. And Adam Gaffney lays this out. This is the president of Physicians for a National Health System. And he literally helped Pramila Jayapal write her Medicare for All Bill, which does get rid of private insurance companies. Now, here's what he said in an op-ed for the nation. The only way to make room for a significant role for private insurance in the American context is to make the public system paltrier or skimpier to impose onerous co-pays and deductibles or to let the rich preferentially displace working class people from hospital beds and doctor's offices. But it doesn't seem to make sense to punch holes in your own floor just to create work for a carpenter. That it's particularly true if your floor is your health care and your carpenter is an extractive insurance giant. Exactly. So Tulsi Gabbard can call this whatever she wants to call it a private option, a public option, but it's not single payer, which is essentially what we've come to expect with Medicare for All. Medicare for All and single payer are synonyms for one another. Right? It's just Medicare for All is branding for single payer. So if you support a private option by definition, you don't support a single payer Medicare for All system. So what you should do at this point is just own it. Just admit I don't support a plan that is as robust as Bernie Sanders, because by saying that you still support Medicare for All, you are actively deceiving people. And I'm not suggesting that Tulsi Gabbard is corrupt. She's not taking money from health insurance companies, as far as I know. But oftentimes it's not only about corruption. Maybe she's just too afraid to stand up to the private health insurance industry who can still destroy her career. Maybe they're not corrupting her, but maybe she's worried that they would bankroll a future primary opponent or something like that. I don't know, but she doesn't support Medicare for All. And she should stop saying that she supports Medicare for All, when in fact she doesn't. Because when we think of Medicare for All, we think of single payer. But what frustrates me is that all of these candidates, they know that Medicare for All is popular, which is why they call it Medicare for America, Medicare for All Who Wanted. If you're Kamala, Medicare for All. If you're Tulsi Gabbard now, Medicare Choice. You're just trying to hijack the framing to sell your watered down version and I don't appreciate that. I would very much like if Tulsi Gabbard was more honest and upfront. And if she's not, then I don't know what to say. I guess I just expected better. And let me just say this. I don't support candidates who don't support Medicare for All. So at this point, if Tulsi Gabbard is not going to support Medicare for All, I have absolutely zero interest in supporting Tulsi Gabbard. That doesn't mean that I'm canceling her or whatever that means. Or however you want to interpret this, that just means that she's not an ideological ally to me. Maybe she is a political ally. Maybe her and Bernie can align to take down opponents like Kamala Harris. But at this point, I have no interest in supporting a candidate who does not support Medicare for All. That is my litmus test. And if you fail that one strike throughout, I have no interest in supporting you further than that. So I mean, I'm glad that Tulsi Gabbard clarified here. But now she needs to actually do the right thing and just admit that she doesn't support Medicare for All. This is not single payer. What she's describing is basically a public option or according to her. It's a private option. Either way, multi payer system. That's what that is. It's not single payer. Stop calling it single payer. It's not Medicare for All. You don't support Medicare for All. Stop lying. Stop gaslighting. This comes from a place of love. And let me just say this. This is what happens when you don't criticize candidates. See, I have always argued that constructive criticism is important. And if we gatekeep, if we tell people, no, no, no, don't criticize the candidate I like, then this is what happens. They end up getting out of line and doing things that their base doesn't like. And Tulsi Gabbard right now is rightfully being criticized by people who used to support her, people who donated her because this is disappointing. You got popular by being affiliated with Bernie Sanders and supposedly supporting all of the policy ideals that he supported. So now if you're surprised that we're being critical of you because you're backing away from one of the most important policies that we've been fighting for, then don't be surprised because we want you to support Medicare for All. And even if you come around to when you support it, just the fact that you wavered on this shows me that you are not going to fight for. It's the same thing like Elizabeth Warren. Once you start wavering, you can never regain that trust back that you lost with me. So there's one person who will fight for Medicare for All. And that is Bernie Sanders. Period. End of story. There's no discussion to be had. If you want Medicare for All, you vote for Bernie Sanders.