Warren’s campaign carries burden of ‘Medicare for All’

Between the collapse of George W. Bush’s presidency and the rise of Donald Trump, the Republican Party was a more ideological institution than the Democratic Party. Both parties had litmus tests and orthodoxies, but the GOP had more of a “movement” spirit, reflecting the conservatism that had captured it, and ideological enforcers had more influence over its policy debates, more power to decree who counted as a “true conservative” and who was a “Republican in Name Only.”

In this period Republican primary debates became more implausible and fairy tale-ish than their Democratic counterparts, with long-shot candidates competing to outdo one another in ideological zeal, and center-right politicians like John McCain and Mitt Romney trying awkwardly to adopt the language of activists to prove their bona fides.

Now something similar has happened to the Democrats. The party’s leftward march began in Barack Obama’s second term, and Hillary Clinton lost in 2016 in part because she abjured her husband’s popular legacy of centrism. Mirroring how tea partyers reacted to McCain’s 2008 defeat, the Clinton debacle persuaded many liberals that a still-more-ideological party was needed.

The perils of becoming an ideological party are often framed in terms of culture-war issues, with Beto O’Rourke’s promises to seize guns and tax churches the liberal equivalent of Michele Bachmann’s crusading zeal. But ultimately ideological enforcement hurt McCain and Romney much more on pocketbook issues, health care and taxes especially, where under conservative pressure, they ended up staking out positions that became anchors on their general-election campaigns.

That is the danger facing the Democrats, and particularly their quasi-front-runner Elizabeth Warren, with the issue of “Medicare for All.” Single-payer health care is, in certain ways, the liberal-activist equivalent of the conservative dream of a flat tax. It’s an idea of some merit if you’re designing a system from scratch, and it polls OK if you don’t tell people about the trade-offs. And it has enough political vulnerabilities, in terms of costs and disruption both, that no sane Democrat should want it as the centerpiece of their national campaign.

Warren clearly doesn’t want to make it her centerpiece; you can tell that she’d like to run on her promise to tax the wealthy to pay for free child care and college, with a dose of anti-corruption and trustbusting on the side. These ideas have their own difficulties, but they’re popular and responsive to the voters, and a good foil for Trump’s record of corporate tax cuts.

But being a progressive candidate in a leftward-marching party required her to sign on to Medicare for All, and being the “I’ve got a plan for that” candidate in a party that still fetishizes wonkery required her to roll out a big, multitrillion-dollar proposal Friday. So now if Warren wins the nomination, she’s going to drag a multitrillion-dollar renovation of the U.S. health care system into the fall campaign — even though everyone understands that the renovation won’t happen.

Team Warren and its many adjuncts in the press will argue that one, this is the primary campaign and there’s time to pivot toward the center, and two, that Warren’s plan is superclever in its avoidance of overt middle-class taxation.

The second point seems weak to me; the potent fear of health insurance disruption will suffice to make Medicare for All a liability.