Just like Obama’s false promise 10 years ago, the Biden-Buttigieg promise that you can keep your plan is a lie. As Seema Verma, head of the Centers for Medicare and Medicaid Services, has explained, “the public option is a Trojan horse with single-payer hiding inside.” Verma points out that private insurance pays hospitals 75 percent more than Medicare for the same services. In 2017, for example, Medicare underpaid hospitals by $54 billion. They make up the lost revenue by charging private insurers more — which means private plans are essentially subsidizing Medicare for seniors.

But if tens of millions of Americans under 65 sign up for a public option, the population requiring subsidies will expand dramatically, while the source of private revenue will dry up. To stay afloat, doctors and hospitals will have to charge even higher prices to private insurers, which in turn will force insurers to raise prices and reduce services — making it harder for them to compete with the government for customers. A death spiral for private insurance will ensue. The higher private insurance premiums go, the more people will be pushed into the public option — until eventually the private option all but disappears.

In other words, the end result of Medicare-for-all and “Medicare for All Who Want It” is exactly the same: the elimination of private insurance. It’s only a question of whether it is eliminated instantly or dies a slow, painful death.