Elizabeth Warren’s Medicare-for-All Dilemma | The New Yorker
In September, 2017, as Republicans in Congress were pursuing an effort to abolish the Affordable Care Act—which ultimately failed in the Senate by one vote—Senator Bernie Sanders introduced the Medicare for All Act of 2017, which would have enrolled all Americans in a new national health-insurance scheme called the Universal Medicare Program. “At a time when millions of Americans do not have access to affordable health care, the Republicans, funded by the Koch brothers, are trying to take away health care from up to thirty two million more,” Sanders said. “We have a better idea: guarantee health care to all people as a right, not a privilege.”
Although the Medicare for All Act was primarily identified with Sanders, who had proposed the same idea during his 2016 Presidential bid, it was co-sponsored by sixteen other Democratic senators. At least six of them were also considered to be possible 2020 Presidential candidates: Corey Booker, Al Franken, Kirsten Gillibrand, Kamala Harris, Jeff Merkley, and Elizabeth Warren. The bill had the endorsement of a large number of progressive groups, including Our Revolution, MoveOn, the Working Families Party, Friends of the Earth, CREDO, and the Progressive Campaign Change Committee. With the G.O.P. in control of both houses of Congress, the bill went nowhere, but the support it achieved confirmed that many progressive Democrats were eager to move beyond Obamacare and embrace a single-payer system.
In April of this year, Sanders reintroduced his Medicare for All Act and issued a white paper laying out some options for financing such a system, which, according to an Urban Institute study of Sanders’s 2016 campaign proposal, would ultimately raise federal expenditures by about three trillion dollars a year. The options included higher taxes on the rich; a 7.5 per cent payroll tax paid by employers; and a “4 percent income-based premium paid by employees, exempting the first $29,000 in income for a family of four.” Because private-insurance plans would be eliminated under the Sanders bill, insurance premiums would also vanish, and the white paper asserted that “the average American family will save thousands of dollars a year because it will no longer be writing large checks to private health insurance companies.” Still, the fact remained that implementing Medicare for All would likely require raising income taxes on a majority of American households.
By April, Franken had resigned, and Merkley had decided not to enter the 2020 race. The four confirmed contenders from the Senate, aside from Sanders—Booker, Gillibrand, Harris, and Warren—all co-sponsored the Medicare for All Act again, which was hardly surprising. If they had backed away from the Sanders bill, they would have attracted criticism from the left. None of them were doing particularly well in the polls at the time, and so sticking to their prior position must have seemed like the safest political move.
Even so, at least a couple of them tried to preserve some wiggle room. Warren started out the year by portraying her support for Medicare for All as a statement about aspirations rather than a commitment to the particulars of the Sanders plan. In an interview with Bloomberg Television, in January, she identified “affordable health care for every American” as her goal and said that there were “different ways we can get there.” At a CNN town-hall meeting in March, she said that there were “a lot of different pathways” to universal coverage, and added, “What we’re all looking for is the lowest cost way to make sure that everybody gets covered.”
But unlike in many other policy areas, Warren didn’t propose an over-all health-care-reform plan of her own, as Harris did, or back away from the commitment to eliminate private insurance, as Booker did, sort of. Warren was rolling out so many proposals that her campaign started selling T-shirts emblazoned with the slogan “WARREN HAS A PLAN FOR THAT.” But in the area of health care, she confined herself to relatively narrow proposals, including measures to reduce the cost of prescription drugs, expand rural health-care programs, and tackle the opioid crisis. (That’s not to say that these proposals weren’t important individually, merely that they didn’t add up to a comprehensive reform plan.)
At the first Democratic debate, in June, Warren said, “I’m with Bernie on Medicare,” and she also raised her hand when the candidates were asked to indicate whether they favored getting rid of private health insurance. But she didn’t emphasize this in her over-all pitch, and she didn’t get pressed on it. Things changed after she began vying for the lead with Joe Biden in the polls. Front-runners get treated differently than mere contenders: the media scrutinizes everything they say and do, and their fellow-candidates try to take them down. During Tuesday’s debate, Biden, Pete Buttigieg, and Amy Klobuchar zeroed in on Warren’s apparent reluctance to acknowledge explicitly that taxes would go up as part of a Medicare for All plan. “We owe it to the American people to tell them where we will send the invoice,” Klobuchar said. In response to these criticisms, Warren restated her support for Medicare for All, but also tweaked it slightly, saying, “I will not sign a bill into law that does not lower costs for middle-class families.”
The debate left Warren with a dilemma. Should she stick to her current position, which is at least partly designed to avoid giving Trump and the Republicans a talking point—“Warren wants to raise your taxes”—or should she refine it in some way? Some progressives believe she is in the right place. “Democratic voters want to beat Trump and appreciate Democratic politicians who are savvy,” Adam Green, a co-founder of the Progressive Change Campaign Committee, told The Hill on Wednesday. “I don’t see why we would give the insurance companies rope to hang Democrats with a deceptive talking point. The bottom line is that Medicare for All will function like a tax cut for families.” Felicia Wong, the president of the Roosevelt Institute, a liberal think tank, also defended Warren’s approach. In an e-mail to me, Wong wrote, “Senator Warren has started with the basics: Everyone needs health care. And everyone agrees that the system isn’t working. So we need a big national conversation about structuring government as a public provider. That’s an upstream fight. And that is the campaign Sen. Warren is running.”
Sticking to the current strategy won’t stop the onslaught from other candidates. On Wednesday, Biden questioned Warren’s “credibility” and said, “She’s going to have to tell the truth or the question will be raised about whether or not she’s going to be candid and honest with the American people.” In an interview with CNN, Buttigieg claimed that, during the debate, Warren was “more specific and forthcoming about the number of selfies she’s taken than about how this plan is going to be funded.”
A second option is for Warren to provide more details about the sort of Medicare for All proposal she would support, and maybe even unveil one of her own. On Wednesday, her campaign took a small step in this direction. In a statement provided to CNN, it said that the candidate was “reviewing the revenue options suggested by the 2016 Bernie campaign along with other revenue options. But she will only support pay-fors that meet the principles she has laid out in multiple debates.” The CNN report said that the Warren campaign “declined to comment on whether Warren may eventually put out her own details on paying for Medicare for All.” The potential danger of proceeding down this path is that it might further enmesh Warren in the fiendish complexities of health-care reform, which could divert attention away from her many other plans, including her wealth tax and proposal for universal child care.
Warren’s third option, and the one I think she is most likely to choose, involves qualifying her commitment to Medicare for All by again emphasizing its aspirational nature, and stressing that, if she does get elected, other priorities would come first. Adopting this strategy would be less of a reversal than a return to where she started. In an interview with Vox’s Ezra Klein, shortly before the debate in June, Warren said that her first two priorities would be pursuing her anti-corruption package, which would severely restrict the activities of lobbyists and create a new U.S. Office of Public Integrity, and passing her wealth tax. She said that Medicare for All was a “fight that matters to me” but didn’t give any timetable for engaging in it.
Just like the other two strategies, this one would have potential costs. Supporters of Sanders, who is reportedly about to receive the endorsement of Representative Alexandria Ocasio-Cortez, could well accuse Warren of backsliding. Other Democratic primary voters, many of whom identify health care as their biggest policy concern, may get a bit confused. But moving in this direction would have the great merit of accurately reflecting Warren’s over-all policy platform. Sanders, to his credit, has doggedly supported socialized medicine for decades, even when it was far less popular than it is today. He has other policies, but Medicare for All is his signature plan. If he were to win the Democratic nomination and the general election, he would certainly try to enact some version of his Medicare for All Act, and the effort would likely consume much his Presidency, just as passing the Affordable Care Act consumed much of Obama’s first term. Warren is in a different position. Rather than having her name attached to a single issue, she wants to lead a wide-ranging effort to correct some of the excesses and failures of twenty-first-century capitalism and create a new social contract. Given the range and depth of the policy proposals she has put forward, she can credibly claim to have laid out a framework for beginning such a transformation, which could ultimately include the introduction of a single-payer health-care plan that guarantees universal coverage. At the moment, though, her ill-defined association with Sanders’s Medicare for All proposal risks obscuring the rest of her program. I would expect her to clarify it, and soon.