During a summer debate moderators asked those on stage whether they personally would adopt a government run healthcare plan as part of Medicare for All. Elizabeth Warren raised her hand and stated she was “with Bernie” when it came to Medicare for All. In the following months this position has been scrutinized by other candidates, particularly Mayor Pete Buttigieg, and in response Elizabeth Warren has walked back her support, adopting a plan that looks increasingly closer to Buttigieg’s than Bernie’s.
Pete Buttigieg went on the offensive during the next debate and criticized Elizabeth Warren’s plan to fund Medicare for All, characterizing it as blowing a “multi-trillion dollar hole” in the federal budget. Warren responded by highlighting how her plan will raise costs for the wealthy and large corporations, but would not raise taxes on middle class families. That’s similar to the Bernie Sanders response, who’s plan does come with a tax hike, which he continually states will on net cost families less than they currently pay for private health insurance. Something about this response must have been lacking for the Warren camp, because soon after the debate she back tracked her support of Medicare for All.
Emphasis on Choice and Medicare “For Everyone Else Who Wants It”
Instead of supporting a wholesale abolition of private insurance as the Bernie Sanders plan lays out, soon after the debate Elizabeth Warren unveiled a new position that looks suspiciously like “Medicare for All who want it.” Opting instead to push for Medicare for All three years after allowing “those who want it” to buy into Medicare for All using a public option over the course of those first three years.
This is the healthcare message she has brought to Iowa and early primary states ever since. “We’re going to push through… full health care coverage at no cost for everyone else who wants it, you can buy it for a modest amount. You don’t have to but it’s your choice,” she told a crowd in Clinton, Iowa. She went on to say, “at the same time we will lower the age of Medicare to 50. Anybody who wants to go into the Medicare system can go into it if they want to.”
When pressed on the change in language she told NBC’s Deepa Shivaram, “people are going to have a choice to experience it, and they’re going to have a choice at that point.”
In a recent New Hampshire rally her language was much the same and also emphasized choice, “I’ll give everyone the choice to switch from their current insurance to a Medicare for All option that would be free for 135 million Americans on day one and available to everyone else at a modest cost.”
This is a big departure from the standard Bernie Sanders set with his Medicare for All legislation that Elizabeth Warren signed on to early in the primary. The focus on choice is meant to be a compromise with the moderate wing of the party, which champions the public option supported by the likes of Joe Biden and Pete Buttigieg. However, it’s really just a dog whistle for those who support market fundamentalism over the need to provide adequate healthcare to everyone.
“Choice” is a Step Back, People Just Want High Quality Healthcare
The emphasis on choice sounds nice, especially to those who can already afford quality healthcare. However for millions of Americans who are uninsured or under-insured, choice effectively means locking them out of the system. Bernie Sanders seems to have the right response to this choice rhetoric, pointing out it will just create a two tiered system, leaving public insurance for the poor and the sick, and private insurance for the healthy and rich.
In Bernie’s words while attacking Pete Buttigieg’s version of a public option, “when you talk about having a system where you’re going to have private insurance and you’re going to have (a public) option going in, the rich and the healthy will go into private insurance, the poor and the sick will go into Medicare and cost that system an enormous amount of money. It’s a failed idea in my view.”
The pay for care nature of American healthcare is the root of the problem right now. Millions of Americans don’t have a choice but to pay for care with premiums and deductibles that makes it close to unusable anyway. For many Americans Medicaid or Medicare are their only choice. The bifurcated system Bernie Sanders describes already exists, and as he predicted the poor and the sick already rely on the public system. Which drives up costs and leaves the public system vulnerable to politically motivated attacks from Republicans and others who seize on these costs.
Elizabeth Warren’s proposed public option plan isn’t that far off the Buttigieg plan. The only difference is the eventual goal of transferring the entire system to a Medicare for All public system. Which itself poses a significant political problem, is a transition to Medicare for All, three years later, even possible? The answer, probably not. Medicare for All will be a gargantuan political project. Abolishing private insurance and moving all to a high quality public system has to be the goal, letting it become a second order consequence of a public option simply isn’t feasible if that end goal is actually taken seriously. Which is why Bernie Sanders’ Medicare for All plan remains the gold standard. It won’t be easy, but he’s the only one who seems to understand the political fight required and won’t water down his legislation to appease the center.
Elizabeth Warren was on the right track, but her public option/Medicare for All hybrid simply won’t do.