When Sen. Elizabeth Warren, a Massachusetts Democrat and presidential primary front-runner, revealed Friday that she was willing to defer the most controversial element of her “Medicare for All” plan ― the replacement of nearly all private insurance with a single government program ― until the third year of her presidency, she found herself in the unenviable position of taking fire from both her left and her right.
The democratic socialists who make up the policy’s most ardent champions saw confirmation that her commitment to achieving single-payer health care is weak at best, while her centrist critics saw a political concession that did nothing to diminish their central problem with her plan.
It was a beleaguered position that essentially matched where Warren was some six weeks ago, when pressure was mounting for her to release a more detailed Medicare for All plan. Her campaign had hoped that by first releasing a plan on how to finance the ambitious program without raising middle-class taxes and then two weeks later promising to enact it gradually, that it would quiet some of the critics and allow her to move forward with her campaign. But as even some sympathetic analysts admit, in the short term, Warren has done neither of those things.
Wednesday’s debate is an opportunity for her to finally reverse that dynamic and put her moderate rivals on the defensive for the first time in roughly two months. But doing so might require Warren to be more aggressive than she was at earlier debates, according to interviews with some of her allies.
Joe Dinkin, national campaigns director for the Working Families Party, a major progressive group that endorsed Warren in September, called for her to use the debate to return to her campaign’s core themes of fixing a political system riven with greed and corruption.
“She needs to be herself,” Dinkin said. “That means she needs to explain to people in the way that only she can how our economy and our democracy have been twisted and distorted, who is responsible and how we’re going to come together to fix it. That’s the campaign that is inspiring people and expanding the progressive movement.”
Warren is indeed at her most comfortable discussing the broad theme of a “government that works great for those with money and connections and doesn’t work much for anyone else.”
If there’s a single policy she ties most closely to that theme, it’s the wealth tax she hopes to levy on multimillion-dollar estates to fund priorities like free public college, student debt cancellation, paid family leave and public child care.
The fee itself ― originally “two cents” on every dollar of assets above $50 million ― is so popular with her base it has become a call-and-response line at her rallies. Unlike abolishing private health insurance, it polls high in the broader population as well. And it has baited billionaire financiers and technology executives into lashing out against her ― and in some cases even embarking on quixotic candidacies seemingly designed to blunt her momentum. The increasingly melodramatic hand-wringing of some of these superrich Americans has been the silver lining in a cloudy month for the Warren campaign.
Warren’s plan to boost Social Security benefits is also fertile terrain for populist campaigning without entering the notoriously perilous thicket of health care policy. To that end, her campaign released a new television advertisement in Iowa on Tuesday touting the proposal, which would immediately increase the program’s monthly payments by $200.
But the moderators of the previous four Democratic debates allotted significant time to the narrow question of Medicare financing, and given the ongoing skirmishes over Warren’s plan, they are unlikely to let up on Wednesday night. (After a town hall in Las Vegas on Sunday, the media continued to pepper Warren with questions about the policy, including questioning how it played with African American voters.)
Ruy Teixeira, a demographer and public opinion expert at the Democratic Party-aligned Center for American Progress who doubts the political wisdom of Warren’s decision to embrace the elimination of most private health insurance, recommended that she bring it back to the big picture.
“She probably has to keep coming back to, ‘You say blah blah blah about my overall Medicare for All plan and how I would pay for it ― what I really want to talk about is what I am going to do when I am elected to help the American people get better health care.… My plan for doing that is better than anyone else’s,’” said Teixeira, author of “The Optimistic Leftist: Why the 21st Century Will Be Better Than You Think.”
A majority of Americans tell pollsters that they support Medicare for All as a vague concept. But when they are informed that such a plan would mean eliminating private health insurance, support typically drops below 50%. Nearly two-thirds of swing voters in the battleground state of Michigan called a Medicare for All plan that eliminates private health insurance a “bad idea,” according to an October poll conducted by the nonpartisan Henry J. Kaiser Family Foundation.
“It’s really not debatable at this point how it plays politically,” said Teixeira, who has not endorsed anyone in the primary. “People are very risk averse.”
Warren’s problem is clearly as much about electability as it is about policy. Alan Abramowitz, a political scientist at Emory University, wrote last week that House candidates who backed Medicare for All in the 2018 midterm elections performed about 5 percentage points worse than candidates who did not, adding ammunition to the centrist argument.
But Warren (and Sanders) got some backup from a somewhat unlikely source: Guy Cecil, the head of the Democratic super PAC Priorities USA, which is neutral in the primary, said it had tested attacks on Medicare for All and other Democratic health care plans. In all scenarios, the Democrats’ approach to health care remains more popular than the GOP’s support of a total repeal of Obamacare, including its protections for people with pre-existing conditions.
“The reality is we maintain an advantage even after the attacks on Medicare for All,” Cecil said.
And Medicare for All defenders are fighting back, arguing the polling numbers just show the need to push a counter-narrative about the program’s benefits. Adam Green, co-founder of the Progressive Change Campaign Committee, which is backing Warren, co-hosted a press call on Tuesday showcasing original polling data on Medicare for All.
The polling, which the Democratic firm GBAO conducted on behalf of the PCCC’s think tank arm, the Progressive Change Institute, as well as Business for Medicare for All and Public Citizen, examined rebuttals to critiques of Medicare for All that emphasized it would abolish private insurance. In the survey, two-thirds of voters continued to favor Medicare for All when an attack noting that it would eliminate private health insurance was rebutted either by reminding voters that the change would be gradual or that it would give Americans a lifetime of portable insurance regardless of their employment status.
Green believes that Warren “laid a trap” for other candidates by laying out her fully baked Medicare for All plans right before the debate.
“If [her rivals] take the bait and get immersed in petty attacks on the details while she stays focused on the big-picture ways her plan avoids medical bankruptcy for families, voters will say she won this debate ― just like they did in prior debates where other candidates obsessed over less relevant details,” he said.
Getting into the details might be hard to avoid for Warren, though, given the comparisons that the first stage of her plan has drawn to the “Medicare for All Who Want It” proposal introduced by South Bend, Indiana, Mayor Pete Buttigieg. Warren has promised to use budget reconciliation to pass a new, public health insurance option in her first two years in office and lower the eligibility age of traditional Medicare to 50. The heart of Buttigieg’s plan includes the former feature, though not the latter.
The parallel has become especially popular among Warren’s critics on the socialist left. Simon Narode, a college student in Eugene, Oregon, who supports Sanders, compiled a viral video highlighting similarities in the two candidates’ public statements about Medicare for All over time.
And Warren has struggled to turn the tables on her centrist rivals. During the last debate, she attacked Buttigieg’s plan ― which would not provide health insurance for every American ― as “Medicare for All who can afford it.” The line has not caught on. And Warren has generally bypassed chances to bash her primary rivals.
Mike Lux, a progressive consultant who has endorsed Warren, suggested that she should welcome a competition with Buttigieg.
“Even Warren’s interim proposal is substantively better than Pete’s,” he said, noting that, unlike Buttigieg, Warren also plans to use executive action to immediately lower prescription drug prices, including by threatening pharmaceutical patents.
“Pete and the other folks attacking her on health care have taken a lot of money from the health care industry,” Lux added.
Teixeira also suggested that she cast doubt on Buttigieg’s experience implementing complex policies and his credibility as a fighter for ordinary people.
“That could play into pushing her new transition plan ― ‘I know how to get this done and I’m totally committed to it,’” he imagined her saying. “‘And what do you know how to do, Mayor Pete?’”
That might be an easier task after video resurfaced on Tuesday of Buttigieg addressing a tea party group in 2010, when the conservative activist movement was seeking to torpedo the Affordable Care Act.
Dinkin, of the Working Families Party, would not say that Warren should herself go on the attack against Buttigieg. But he predicted that Buttigieg will “have to answer” for his presence at the tea party event.