Elizabeth Warren, a politician for whom I have a great deal of admiration, is lying to you.
If elected, she’s not going to pass Medicare For All.
Warren’s rivals in the Democratic primary are hammering away at the fact that the candidate who has a detailed plan for nearly every liberal domestic policy initiative hasn’t explained how Medicare For All would be implemented under her stewardship. They’re correct that this sleight of hand is disingenuous. But it’s not for the reasons they’re saying: Because the truth is, nobody—not even Bernie Sanders—really knows how to pay for M4A.
According to a Monday report in the Times, Warren said she will release a detailed plan to pay for M4A that she claims to have been working on for “months and months,” which either means she’s about to go Full Mondale (that is, propose across-the-board tax increases, which is why you never go Full Mondale) or her team is about to unveil a Frankenstein’s monster of Trumpian-level accounting tricks and fire-breathing populist rate hikes on the rich and sorta-rich.
Either way, it’s going to be a bad look, and it’s all for naught. There’s a reason she barely mentions M4A in her stump speech: she knows it’s political quicksand, and I hope she doesn’t get sucked in.
Healthcare in this country is suboptimal. The insurance companies suck. It’s too expensive. The fees don’t correlate with costs. But you know what sucks even more? The politics of health care.
When I said that Elizabeth Warren was lying about passing M4A, let me be clear: I believe Warren would gladly sign M4A into law if Nancy Pelosi and Chuck Schumer magically decided to pass the Sanders-penned legislation through Congress. Spoiler: This is not going to happen.
I was a press staffer in the House during the first year of work on Obamacare and it was awful: it’s tedious, incredibly complicated, impossible to explain, and if you screw it up, people die. Americans are right to be suspicious of the government’s ability to implement such sweeping, structural reforms: we couldn’t even launch a website when Obamacare was set to go live. Nobody died because of that website, but if hospitals can’t charge anything but Medicare rates, many of them won’t be able to cover their costs; so more hospitals will close, and many people in rural areas won’t be able to get treatment quickly or at all. People could die.
Adding a public option to Obamacare would be, to quote Joe Biden, “a big fucking deal.” It would be more transformational than the original bill. You remember how easy that was to pass. All it took was two years of backbreaking legislative work, losing Ted Kennedy’s Senate seat in Massachusetts, a walk-the-plank vote for dozens of Democratic representatives, and then the loss of six more Senate seats and control of the House.
In order for a President Warren to have even a chance of making M4A happen, the Democrats would have to flip the Senate. (Which is doable, but a stretch. Especially if Medicare For All is the nominee’s signature domestic policy initiative.)
And if they take the Senate, the Democrats would have to hold onto pretty much every single vote, in both houses. Do you think Joe Manchin is voting for M4A? My congressman, Jim Cooper, is the same guy who shot Hillarycare behind the barn in ’94. He’s still in Congress, along with the 100 or so other moderate Democrats who resisted impeachment until the Ukraine story came to light.
In fact, only 40 percent of Democratic House Members are in the Progressive Caucus, which means—if my math’s right—that the more moderate wing of the Democratic party comprises the majority of the party.
Would the constituents of moderate Democrats’ districts be better off under Sanders’ Medicare For All plan? Undoubtedly. But good luck selling that message at the same time that you’re trying to explain why their taxes are going up all while a multi-billion dollar ad campaign opposing M4A buzzes in the background.
And then there’s the presence of other, light-lift options which aren’t as sexy as M4A, but get us within striking distance to universal access to healthcare.
Meaning that the next Democratic president will have two options:
(1) Put all their chips in the center of the table for Medicare For All, which would be unlikely to pass and, if it did, would probably have adverse consequences for the 2020 election and prevent action on any other policy front.
(2) Expand Obamacare and increase access without forcing the entire Democratic caucus to stick their necks out; pocket the win; and then move on to whatever is the next most important item on the agenda. Like, for instance, climate change.
Every Democratic presidential candidate claims that climate change is an existential threat to the planet. If that’s true—and I happen to think it is—then it would be monumentally irresponsible to go all-in on M4A if there was even the chance that it could cost them passage of climate legislation.
I’m not arguing for incrementalism so much as arguing against political suicide. When a president proposes a total overhaul of the status quo in the healthcare system—good or bad—they’re handing the opposition party somewhere between 40 and 60 House seats in the next election. Presidents Clinton, Obama, and Trump all took on major health care reform in their first terms, and all three watched their legislative majorities crumble in historic midterm shellackings. Happens every damn time. And even if a President Warren could marshal the support of the Jim Coopers and Joe Manchins of the world (lol) to get M4A across the finish line, then she’d have to get ready for Tea Party 2: Alt-Right Bugaloo.
At last week’s Democratic debate, something Pete Buttigieg said stuck with me:
Everyone on this stage, by definition, is competing to be a president for after the Trump presidency. Remember, one way or the other, this presidency is going to come to an end. I want you to picture what it’s going to be like, what it’s actually going to feel like in this country the first day the sun comes up after Donald Trump has been president. It starts out feeling like a happy thought; this particular brand of chaos and corruption will be over. But really think about where we’ll be: vulnerable, even more torn apart by politics than we are right now. And these big issues from the economy to climate change have not taken a vacation during [the Trump administration].
Mayor Pete is absolutely correct about the state this country will be in after Trump. And so the prospect of another Tea Party movement taking flight shouldn’t be waved away as if it was just the cost of doing business. It can be true that Medicare For All is both the best policy and the policy most likely to burn the whole place down.
And not to put too fine a point on it, but our politicians ought to prove to the public that they can be trusted to undertake something as bold as the nationalization of the healthcare industry before we let them do it.
Let’s give the Feds a chance to do something that could make significant positive change and restore faith in government and institutions without monkeying with literal life and death if they screw it up. Do infrastructure! Or a universal basic income!
Or pass Warren’s 2 percent wealth tax—which will actually be her major legislative priority—since she claims it will pay for “universal child care for every baby 0 to 5, universal pre-K, universal college and knock back the student loan debt burden for 95 percent of our students and still have nearly a trillion dollars left over.”
Or, if you want to win over the deficit hawks before embarking on a spending spree, create Fed Accounts For All, which is a deficit reducing reform in which everyone with a Social Security number would be given a bank account at the Federal Reserve. Fed Accounts would, among other things, have the benefit of putting an entire industry of blood suckers—the payday lending sharks—out of business. It’s a tremendous, and very big, idea. You should read the whole thing. (Disclosure: It was proposed by a friend of mine, Vanderbilt Professor Morgan Ricks.)
The Medicare For All absolutists take a hard-line approach to what constitutes acceptable coverage. Here, for instance, is Libby Watson at the New Republic making the case against mere Obamacare reform and expansion and for Full M4A:
Are you positive that your Deserving Poor Matrix is generous enough to cover everyone, every eventuality, without anyone ever losing coverage because your math couldn’t capture the vast range of human experience, misery, and misfortune in America?
The answer to Watson’s question, of course, is no.
But that isn’t really the point. Because if your goal is to cover every experience, misery, and misfortune, then what you’re asking for isn’t a heavy payload policy project. You’re asking for what Bernie Sanders has, time and again, referred to as a “political and economic revolution in this country.”
And credit to Bernie Sanders: At least he’s honest about it. His organization is literally called “Our Revolution.” If his supporters really want to reap the rewards of Sanders’ transformative policy agenda, then they have to take their message to the streets and earn it. It’s what happens in other countries and it works. One of the big benefits of a revolution is that its objectives need not be tethered to the political realities of the moment, like, for instance, convincing Joe Manchin to vote with you. We wouldn’t have to think “for months and months” about how to pay for stuff like M4A, we’d just do it and be legends, man.