For a few weeks, the behind-the-scenes grumbling was getting louder in precincts of the left supportive of Bernie Sanders: What, exactly, was Elizabeth Warren’s position on health care? She was an outspoken proponent of Medicare for All, sure, but they wanted more clarity on her position about whether private insurance should remain an option. Warren’s campaign team and her allies could hear the whispers — and they were just whispers, while Sanders backers tiptoe around the question of how to engage with Warren. So as Wednesday night’s debate neared, they figured she’d answer them. When Lester Holt asked for a show of hands, then, the senator was ready, and her team was not surprised at the question: “Who here would abolish their private health insurance in favor of a government-run plan?”
Now a legitimate contender for the nomination, Warren’s decision to raise her hand was both a straightforward policy choice — she’s signed onto Sanders’s Medicare for All bill, and this is what it entails; this is what she believes — and part of her broader bet about what really matters in general elections.
The question of how to handle this particular issue has been fraught for the Democratic primary field — just ask Kamala Harris — and independent strategists and analysts, and some of Warren’s opponents, quickly warned that this unpopular position would be politically poisonous in a general election in which she’d need to win over moderate voters. “Every Republican strategist last night was salivating,” Massachusetts congressman Seth Moulton, a 2020 long shot, told reporters over breakfast the next morning. “She may have just filmed the most effective attack against herself,” wrote Jonathan Chait for Intelligencer, noting that Warren has spoken of reforming private insurance in the recent past.
Yet Warren chose to be declarative, leaving the ambiguity to others who’d signed on to Sanders’s bill but didn’t raise their hands, like Cory Booker. She didn’t rule out more incremental health-care moves before achieving Medicare for All, but her response — which began, “I’m with Bernie on Medicare for All” — was intended to answer the question clearly for anyone who’d been wondering. She could not afford to look wishy-washy on a core issue in the eyes of the left, her allies believe, if she wants to fully win over that wing of the party while trying to expand her appeal in the opposite direction, too.
But the answer was also in keeping with a broader political philosophy that colors Warren’s effort, and Sanders’s, too. Neither Warren nor those around her have ever bought into the idea that proposals like this one are sufficiently potent ammunition for Republicans to warrant backing off. It’s common for her supporters, and Sanders’s, to point out that Republicans will likely accuse Democrats of wanting the most extreme possible version of their policies anyway — open borders! Full socialism! Gun confiscation! — regardless of the identity of the nominee, so moderating to avoid that is a fool’s errand that would only alienate their own backers. “There are a lot of politicians who say, ‘Oh, it’s just not possible, we can’t do it,’” Warren told Holt. “[They] have a lot of political reasons for this.”
And Warren’s answer exposed how she plans to use the issue as part of her economic populist pitch, in part by keying in on Americans’ displeasure with private insurance companies. “I spent a big chunk of my life studying why families go broke. And one of the number-one reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance. It’s for people who have insurance. Look at the business model of an insurance company. It’s to bring in as many dollars as they can in premiums, and to pay out as few dollars as possible for your health care. That leaves families with rising premiums, rising co-pays, and fighting with insurance companies to try to get the health care that their doctors say that they and their children need,” she said.
Just as she’s grown her support in recent months by introducing policy after policy to tell a broader story of economic injustice, she is hoping to paint this issue as a matter of basic fairness, thereby aiming to mitigate the policy’s relative unpopularity in polling when voters hear about the elimination of private insurance. “Medicare for all,” she said, “solves that problem.”