vision 2020

Warren Sensibly Avoids Medicare for All Fantasy World

Elizabeth Warren is hardly a triangulator. Photo: Scott Olson/Getty Images

At some point in the 2020 campaign cycle prior to last month, it became apparent to Elizabeth Warren and/or the people around her that there was a glaring contradiction in the middle of her much-praised policy platform. On one hand, she had a host of “plans,” detailed and practical proposals for achieving some progressive goal or other. She was also very interested in articulating a “theory of change” about how some of her more ambitious proposals might actually be implemented in the face of Republican and interest-group resistance. On the other hand, she was a conspicuous supporter of Bernie Sanders’s version of Medicare for All legislation, which many progressives promoted in a militant, no-compromise manner, with Sanders himself not offering much of a theory of change about to improve its currently remote feasibility, other than stipulating a “political revolution.” Whatever else you think about it, that’s no Warren-style “plan.”

So inevitably, in mid-November, under pressure to make her own position more complete, she released a two-stage plan for full implementation of Medicare for All during her initial term as president. She immediately got attacked from the left for backtracking, because during the first stage, people would not be immediately forced to give up their existing employer-based insurance. She also drew criticism from the center and right for still advocating the abolition of private health insurance in the second stage. Perhaps more insidiously, the impression developed that she was tacking with the political winds rather than simply bringing her (and Sanders’s) proposal down to planet Earth, where there is no way Medicare for All is going to have the support in Congress necessary to enact it in 2021, thanks to extensive Democratic opposition and total Republican opposition.

Now, in an environment where the hep political world has decided Warren’s on the ropes (because her impressive surge in public support has for the moment subsided), she’s under renewed attack for discussing her implementation plan for Medicare for All in a manner that makes the first stage sound too attractive rather than politically forced castor oil. Here’s a Bloomberg News report that makes it sound like she’s practically snuggling up to private health insurers:

Democratic presidential candidate Elizabeth Warren is starting to back away from a full-blown Medicare for All plan on the campaign trail, as she faces increased questions about whether her support for the proposal hurts her electability.

After pushing the swift creation of a government-run health care system that would cover all Americans and eliminate private insurance, Warren is now emphasizing her calls for a transition period that would make it optional for most of her first term in office.

During a three-day bus tour through Iowa, she increasingly stressed the word “choice” in her interactions with voters, saying the three-year implementation period would let Americans keep their existing coverage or try out Medicare for All.

“We’re going to push through health care that’s available to everyone,” Warren said during a town hall in Clinton, Iowa, on Saturday. “You don’t have to, but it’s your choice, if you want to come in and get full health care coverage.”

That is, of course, a completely accurate description of the plan she’s had on the table for over a month now. And she has always made it plain that the reason she thinks a full Medicare for All implementation will be possible during the second stage (just three years after she is inaugurated) is that many Americans will choose to support the public health-care plan once they’ve seen it.

There seems to be an idea out there that the word “choice” in health care is incompatible with Medicare for All, as this Noah Rothman comment on Warren’s rhetoric suggests:

Elizabeth Warren is only the latest erstwhile advocate of a virtual state-run health-insurance monopoly to abandon the proposal. She will surely deny that she has backtracked at all, but her behavior suggests otherwise. At an appearance on the campaign trail over the weekend, Sen. Warren introduced a new word into her pitch for health-care reform: “choice.”

I don’t know where Rothman has been, but Medicare for All advocates talk about “choice” all the time: having a full choice of doctors (which many private insurance plans restrict) and other providers, a choice of treatments and prescription drugs (ditto), and most fundamentally, a choice to access health care without going broke or accepting inferior care. Choice does not strictly refer to the theoretical availability of multiple health insurers; making that some sort of matter of basic human freedom obviously rules out single-payer health plans by definition.

Warren has a very clear position in favor of Medicare for All, but does not succumb to the common progressive mistake of acting as though refusing to contemplate compromise guarantees success — as though Democratic willpower alone is all that is keeps America from falling short of what progressives want. If anything, I think she’s still too optimistic about how rapidly Medicare for All can be enacted, but she’s made an effort, unlike Sanders, to chart the path from here to there. And if some fearful voters find solace in the first stage of her implementation plan, I don’t understand why Warren should be criticized for assuaging their fears. This is a pol who hardly goes 30 seconds without promising to fight for progressive goals. She should probably be trusted not to backtrack on this very central issue if there’s any practicable way forward.

Warren Sensibly Avoids Medicare for All Fantasy World