Call & Times

But does Warren have a plan for health care?

- By PAUL WALDMAN

There isn’t much doubt who has the momentum (for whatever that’s worth) in the Democratic presidenti­al primaries. Sen. Elizabeth Warren, D-Mass., is drawing huge crowds. While Joe Biden and Bernie Sanders are dropping in many polls, she’s rising; a new Monmouth University poll shows the three tied for first place nationally.

Meanwhile, Warren seems to be wowing voters and party insiders alike. And a big part of her appeal is the image she has cultivated as the candidate who has thought the most about the challenges of governing, with a plan for everything. So where’s her health care plan?

It’s an almost bizarre omission that barely anyone has seemed to notice, given that it’s the domestic issue that gets more discussion than any other. It’s not that Warren doesn’t talk about health care or that she hasn’t been clear about what she believes in a general sense, because she does and she has.

But so far she has avoided some of the trickiest questions by not putting specifics down on paper. Warren co-sponsored Bernie Sanders’ Medicare-for-all bill in Congress, but she has also co-sponsored other bills offering substantia­l but less sweeping reforms. And whenever she talks about the issue, she discusses different priorities for different time periods: Right now, stop the Republican assault on the Affordable Care Act; then start expanding coverage and strictly regulating insurance companies; ultimately move to Medicare-for-all to cover everyone.

We should say that a lot of requests to clarify health care details are often little more than bad-faith attempts to get them to say something they’ll be attacked for (“Are you gonna raise taxes? Are you? Are you?”). But the details are important, even if some of them may change as any proposal is wrung through the legislativ­e grinder.

When you’re forced to get specific, people will inevitably find things to criticize. If Warren releases something like Sanders’ plan, it’ll be called unrealisti­c; if she takes a more step-by-step approach to reform, some on the left will call it a betrayal.

We saw this with Kamala Harris, who had made statements similar to Warren’s about supporting Medicare-for-all and getting rid of insurance companies that provide no real added value, extract profits, and make people’s lives miserable and full of uncertaint­y and fear. But when Harris released her plan, it was criticized as an attempt to not turn her back on what she had promised while accommodat­ing the criticisms Medicare-for-all had received, particular­ly the worries about people losing private coverage.

For the record, I thought much of that criticism was unfair, particular­ly the idea that the 10-year transition to (nearly) full single-payer in Harris’ plan was too slow. That kind of ambitious reform will be incredibly disruptive even if it brings us to a better system, and ten years is not too long to make sure it’s happening in the right way.

Neverthele­ss, no plan from a candidate can be immune to political considerat­ions, and one thing all the candidates are surely considerin­g is that recent polls seem to show a shift away from Medicare-for-all of the kind Sanders proposes – a true single-payer system in which private insurers have little or no role almost from the outset – and toward something more like Medicare-for-anyone, a voluntary system which would beef up public insurance and cover all the uninsured but wouldn’t be mandatory.

In some formulatio­ns that’s an end point, while in others it’s a means to achieve Medicare-for-all over time, as people steadily realize the public plan is better and abandon private insurance for it (this is how Kirsten Gillibrand, for instance, describes her vision). But either way, it seems to be hitting some kind of public opinion sweet spot; recent polls have shown substantia­lly more support even among Democrats for a system based on a public option than one that eliminates private insurance quickly.

I would be shocked if Warren and her policy team aren’t well aware of the shape of public opinion, even as they’re trying to come up with the most effective plan they can.

The longer she waits, the more time she has to see how things shake out and come up with something that will solve the system’s problems without engenderin­g too much of a campaign backlash. But she won’t be able to wait for much longer.

Paul Waldman is an for the Plum Line blog.

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