Elizabeth Warren’s Medicare for All Dilemma

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: Cory 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.”


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