In an earlier post, I pointed out that there is no better chance of passing a Medicare for all health care plan through Congress in the coming years than there was in 1977, or 1993, or 2009.

Then Elizabeth Warren showed us just how politically unrealistic single-payer health care is when she released her funding plan and then quickly backtracked to the public option approach in the face of rapidly declining polls.

In a separate post, I pointed out that single-payer advocates, like Sanders and Warren, have yet to answer the biggest financial questions surrounding putting the entire country on a single government reimbursement system: How will their paying providers Medicare rates for everything not bankrupt hospitals and doctors? And, if they don’t pay providers these lower Medicare rates, how will their proposals save us any money?

In another post, I argued that the original Biden plan had the best chance of passage through the next Congress and contained all of the essential ingredients to fix what has been wrong with Obamacare for the first ten years of its life — in particular fixing the horrible impact it has had on middle-class consumers who buy their health insurance in the individual market.

Subsequently, Pete Buttigieg and Mike Bloomberg adopted proposals very similar to Biden’s.

In another post I argued that with Trump and the Republicans not even having a plan, and based upon their policy efforts to date that would’ve made the individual market a lot worse, at least so far they aren’t even in the running for who could do the best job of fixing the system.

So, to me, the conclusion is obvious:

• Biden, Buttigieg, and Bloomberg have plans that could easily pass a Democratic-controlled Congress.
• Their plans would make the individual health insurance market workable for everyone in that market.
• Their plans would preserve the Medicaid expansion that is working to provide health insurance to people that under no circumstances could afford coverage in any other system.
• Their plans would continue the unqualified coverage of those with pre-existing conditions.
• Their plans would leave intact the employer-based system that consumers still largely support.
• Their plans would not create a financial upheaval among health care providers that a single-payer plan would.

I can’t say that about any other candidate: Republican or Democrat.

That is not to say their proposals are perfect.

Their biggest problem being how they would pay for it.

For example, Biden and Buttigieg would use the repeal of many of the Republican tax cuts to help pay for their expansion of health care subsidies rather than use any repeal to pay down the federal debt and deficits that the Republican tax cuts created when they were passed — effectively adding much of the cost of their proposals to the national debt. Bloomberg has yet to detail how he would pay for his plan.

And, make no mistake, the Biden outline is a health insurance reform plan — it is not a plan to overhaul a health care system whose costs continue to expand at unaffordable levels.

But at this point, one thing is clear to me, only Biden, Bloomberg, and Buttigieg have plans that have a realistic chance of becoming law — and fixing the health insurance system.

Robert Laszewski is president, Health Policy and Strategy Associates and blogs at Health Care Policy and Marketplace Review.

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