“Why would anyone go through all the trouble of running for president just to get up on stage and talk about what’s not possible?” This is the question Elizabeth Warren posed to thumb-faced millionaire John Delaney at a Democratic debate in July, as paraphrased by her campaign in a tweet, in response to Delaney’s characterization of bold policies as “impossible promises.” And yet it is the logic of possible and impossible, of disarming yourself in an attempt to appease your opponent before you’ve met upon the battlefield, that undergirds Warren’s newly released plan to split up the passage of Medicare for All into two steps: First, the enactment of a public option and then, two years later, the passage of a separate bill to achieve single-payer. It signals that Warren believes that only a public option is possible, without requiring her to say so out loud.
Warren has struggled to voice unequivocal support for single-payer. In March, she said there were “different pathways” to universal coverage, including expanding Medicaid and a buy-in mechanism. She seemed to find her bravery in October, when she released her plan to pay for Medicare for All. Questionable as the proposal was—it relied on a regressive “head tax” of employers, instead of progressive payroll taxes—it did tie her definitively to a single-payer health care plan in a way that she had previously avoided. Few could say she didn’t own the policy once she had outlined the taxes that would pay for it, which is arguably the hardest part of the single-payer pitch. Only now, she’s blown all that up.
Warren’s latest plan ostensibly provides for the “transitioning to Medicare for All.” In reality, it is a clearer indication that she has settled for the public option, like most of the rest of the field. Within the first 100 days of her administration, she proposes to pass a bill allowing anyone to buy into Medicare—while providing it free of charge to children under 18 and anyone making less than 200 percent of the federal poverty level ($51,500 for a family of four). Her administration would use budget reconciliation to avoid the Senate filibuster and pass with only 51 votes—though this process would still require Democratic squishes like Joe Manchin and Kyrsten Sinema to find something resembling conviction.
Warren’s proposal would cap premiums at 5 percent of income—which would be competitive with most, if not all, employer-sponsored insurance; competing plans among the Democratic field peg the cap at 8 percent. The covered benefits would match those enumerated in Bernie Sanders’s Medicare for All bill. Confusingly, she also claims the bill would “gradually decrease to zero” the cost-sharing, like premiums and co-pays, in “subsequent years.” This is essentially saying the public option would morph into free healthcare at some point—like Medicare for All, but without the abolition of private insurance. Who but the obscenely rich would keep paying for private insurance if there’s a free public option that covers everything? And why would such a plan be easier to pass than Medicare for All? Those questions remain unanswered.
What, then, of Medicare for All—the real deal? Warren claims that this would be achieved in her third year in office. It is worth recalling that it wasn’t until March of Barack Obama’s second year in office that the Affordable Care Act was passed. That plan was decidedly less ambitious than the public option and it took five additional years to implement fully. In all likelihood, Warren’s public option—the first stage of her two-stage plan—will take more than 100 days to pass, and most beneficiaries may not be transitioned to her public option by the beginning of 2023. Warren nevertheless argues that “the number of individuals voluntarily remaining in private insurance would likely be quite low” in her third year in office.
But Warren can’t possibly believe that 2023—a year after midterm elections that traditionally tend to reduce the number of legislators in the president’s party—would be a more auspicious time to enact a single-payer bill. Her latest proposal, then, is smoke and mirrors, a red herring—any cliche you like. It looks as if Warren’s feet of clay have returned, and that this proposal merely allows her to continue to claim that she supports Medicare for All. Under a Warren presidency, we would be immensely lucky to see her pass a public option that remains as generous as the one she outlined on her website today. Rallying support in her third year to bring about an even larger overhaul of the system is incredibly quixotic.
Democrats are often so bent on being clever that they end up somewhere incredibly stupid. Seeing the stranglehold that Republicans and the filibuster have put on the Senate, Democrats spend all of their time figuring out their strategy like it’s a puzzle to be solved, a game of chess that’s not worth playing unless success is pre-ordained. What currently passes for policy fights among Democrats boils down to the struggle to discover the magic point where compromise and passage become guaranteed, rather than developing the best possible policy and staking a claim to be the party that will resolve America’s problems. The next Democratic president is going to have to fight very hard to pass anything worth passing, in any policy area—and even the best effort may not be enough. But allowing timid centrists and hostile Republicans to set the boundaries for what’s possible locks in limited possibilities and sends a demoralizing message to the electorate.
If Warren believes that what’s possible is limited to a public option, she should just say so. It would not be illegitimate for Warren to argue that she would rather support a compromise measure that she believes has a better chance of passing—though in that case, she will have to own the substantive inadequacies and diminished public health that arise from that decision. If, however, she actually wants to pass Medicare for All, leaving that project to her third year in office makes no sense—unless the plan is to create an escape hatch from her promise of single-payer. There are two possibilities: Either Warren is naive, or she believes voters to be.