Elizabeth Warren Cuts Bait on Single-Payer Medicare for All, Botches that too


As far as we know, Elizabeth Warren wasn’t a star track athlete. But you wouldn’t know it seeing her flee at the speed of wind from her own single-payer, Medicare for All health care plan.

Almost out of habit, Warren released on Friday what she called her plan to “transition” to single payer. It should be clear to any honest observer, though, that what she is really doing is cutting bait. Given that she dropped this cut-bait plan on a Friday right in the middle of Ambassador Yovanovitch’s public testimony in the impeachment inquiry, one might even be prone to conclude she was trying to skate as much under the radar as possible.

Warren’s plan basically comes down to this: she will shelve actual single-payer Medicare for All legislation for three years, choosing to only introduce it a year after the midterm election in what would be Warren’s first term as president. In the meantime, she proposes to expand and strengthen the Affordable Care Act, provide a Medicare-like public option for people under 50, and Medicare as an option for people between 50 and 64 (if you are a little confused and think this is a distinction without a difference, so do I). Details vary, but this is essentially the idea proposed in Joe Biden’s plan to build on and expand Obamacare, and in Kamala Harris’s plan to have Medicare regulate all private insurance, not just those under present-day Medicare Advantage.

Let me preface the rest of this essay by stating that these plans - whether Warren’s transition state or Biden’s or Harris’s ultimate - are smart, practical, and far-reaching. All of them build on the Affordable Care Act by expanding subsidies, improving coverage, automatically enrolling those without coverage into a public plan, and reforming the markets to make sure treatments and prescription medications can be delivered at a lower price. With the amusing exception that Warren is claiming credit for lowering the price of at least one HIV drug through her plan that will be free under most health plans by the time a new president takes office anyway, all of these plans work and do what they say.

Nevertheless, Warren ostensibly proposes this not as an goal but a path. Her ultimate goal, she still says, is to end up with one single government-only plan that will cover everything under the sun that is still short trillions. In her third year in office, Warren would move to enact that legislation, she says.

So, Warren proposes to pass a massive overhaul of the system after:

  1. Coverage is greatly expanded, costs are significantly reduced, and all or nearly all Americans already have a public or private plan. This raises the question: what problem will we be solving at that point, if Warren’s “transition” plan is successful in meeting these broad goals? What would be the point of changing to yet another system, except just to stick it to the insurance companies?

  2. A midterm election, in which the president’s party typically loses seats in Congress, will have intervened. This raises the question: just who is going to vote for a system-wide shift after the problem has largely been ameliorated (if everything goes according to Warren’s plans) and there are more Republicans and fewer Democrats in a future Congress?

In both of these scenarios - scenarios that are likely to have joined together by the third year of the next presidency, the passage of a single-payer Medicare for All becomes less likely, being far less practically compelling and significantly less politically feasible.

The above two challenges assume that this ‘transition’ plan is successful, leaving a third possibility open: what if the transition is not successful? If it is not successful, does anyone actually believe the same president who has tried and failed at this transition will then be allowed to try what is now admittedly the next and final step? Not a chance.

In other words, if Warren’s transition works, there is no need for a whole new plan. If it doesn’t, she won’t be trusted with a whole new plan. Warren’s transition plan makes no sense if her ultimate goal is to end up with the ideologically pure, single-government-payer, Medicare for All system.

Unless that’s not the goal.

Let’s look at the scenarios again. Given that an expanded Obamacare is the end and not the likely means to get to single-payer (at least during the next presidency), the explanation - the only explanation - that makes sense here is that Warren has given up on expansive, single-payer Medicare for All, and the real transition here is one of Warren moving away from it.

Warren is nothing if not adaptable. She seems to have adapted so well to being a consummate politician that she cannot outright admit her mistake in backing single-payer in the first place (which would have been a lot more honest and earned her a lot of goodwill). Worse yet, she appears afraid of Bernie Sanders and a small group of single-payer-or-bust hardliners. Warren clearly believes that leaving the prospect of single-payer dangling in front of them would be enough to placate them, at least long enough for her to clinch the nomination.

It wasn’t an entirely unreasonable gamble on her part, given the propensity of those who believe anything other than an immediate dismantling of the current system is unacceptable to trust in its magical inevitability. Good try though it was, it didn’t work. Those hardened ideologues are already hashtaging #NoMiddleGround in taking apart and ridiculing Warren’s equivocation.

So here we are. Warren has not just botched the rollout of her plan, and botched the rollout of her mythical-math financing plan, but when she did decide to cut bait, she even did that half-assed.

Who is running this show, anyway?