Elizabeth Warren’s “Transition Plan” for Medicare For All Explained

Senator Elizabeth Warren, D-Mass., released her plan for transitioning the country to a Medicare For All health care system Friday, splitting the effort into two legislative pushes that would happen over her first term in office, but holding off — at first — on ending the role of private insurance companies.

Instead, she would pass legislation to offer new Medicare benefits to everyone first and then follow up with legislation to end existing employer plans by her third year in office, once the new system has a foothold.”

Hosts: Mark Thompson, Ana Kasparian, Michael Brooks

Can Warren Escape the Medicare Trap?

The candidate of plans needs a really good one right now.

On Sunday, Elizabeth Warren said that she would soon release a plan explaining how she intends to pay for “Medicare for all.” Like many policy wonks, I’ll be waiting with bated breath; this could be a make or break moment for her campaign, and possibly for the 2020 election.

There are three things you need to know about Medicare for all, which in the current debate has come to mean a pure single-payer health insurance system, in which the government provides all coverage, with no role for private insurers.

First, single-payer has a lot to recommend it as a way to achieve universal health care. It’s not the only route — every major advanced country besides the United States achieves universal coverage, but many of them get there via regulations and subsidies rather than by relying solely on public insurance. Still, single-payer is clean and simple, and many health economists would support it if we were starting from scratch.

But we aren’t starting from scratch, which is the second thing you need to know. More than half of Americans are covered by private health insurance, mainly through employers.

Not many people love their insurance companies, but that doesn’t mean that they’re eager to trade the coverage they know for a new system they don’t. Most people probably would end up better off under single-payer, but convincing them of that would be a hard sell; polls show much less support for Medicare for all than for a “public option” plan in which people could retain private insurance if they chose to.

Which brings me to the third point: In reality, single-payer won’t happen any time soon. Even if Democrats win in a landslide in 2020, taking control of the Senate as well as the White House, it’s very unlikely that they will have the votes to eliminate private insurance.

Warren, who has made policy seriousness a key part of her political persona — “Warren has a plan for that” — surely knows all of this. And early this year she seemed to recognize the problems with a purist single-payer approach, saying that she was open to different paths toward universal coverage.

Since then, however, she seems to have gone all in for the elimination of private insurance.

I have no inside information about what led her to take that plunge, but my guess is that she was trying to protect her left flank — to avoid alienating supporters of Bernie Sanders, who have made single-payer a kind of purity test one must pass to be considered a true progressive. And I’m not going to criticize her for engaging in a bit of political realism; after all, the case against Medicare for all is itself basically political.

At this point, however, it’s looking as if Warren may have painted herself into a corner.

Part, but only part, of the issue involves cost.

Journalists have been badgering Warren to get specific about how much taxes would have to go up to pay for Medicare for all. She has, with considerable justice, insisted that this is a bad way to frame the discussion, since any additional taxes would be offset by savings on the huge premiums workers and their employers now pay for private insurance — on average, more than $20,000 a year for a family plan.

The right question is whether the overall costs facing U.S. families would go up or down. Warren has been claiming that for most families, they would go down, but she hasn’t offered specifics. And this vagueness, which has started to seem like evasiveness, is more of a problem for her than it might be for other politicians. As I said, Warren has made policy seriousness a key aspect of her political persona, so her fogginess on health care really stands out.

The plan in the works will presumably try to dispel that fog, but doing so will be tricky. An independent estimate from the Urban Institute (which is, for what it’s worth, left-leaning) suggests that a highly comprehensive Medicare-for-all plan, similar to what Sanders is proposing, would substantially increase overall health spending, although a more modest plan wouldn’t.

But cost isn’t the only issue — in fact, I’m not sure how important it really is, given that full abolition of private insurance remains unlikely in practice. Also, let’s get real: If Warren gets the Democratic nomination, the outcome of the general election isn’t going to hinge on dueling think tank estimates.

The election might, however, hinge on the support of people who have good private coverage and would be nervous about making a leap into the unknown, no matter how many facts and figures Warren deploys.

So what I’ll want to see is whether Warren gives herself and her party enough flexibility to assuage these concerns. I’m not sure what form that flexibility might take. Maybe something like an extended transition period, with greatly enhanced Obamacare (which might actually be politically doable) in the interim?

Whatever Warren comes up with, this is a crucial moment. There are many excellent things in her overall policy agenda; but she won’t get a chance to do those things unless she can extricate herself from what looks like a health policy trap.

A Brief History of the Warren Presidency

A crisis of legitimacy swept across American politics in the second decade of the 21st century. Many people had the general conviction that the old order was corrupt and incompetent. There was an inchoate desire for some radical transformation. This mood swept the Republican Party in 2016 as Donald Trump eviscerated the G.O.P. establishment and it swept through the Democratic Party in 2020.

In the 2020 primary race Joe Biden stood as the candidate for linear change and Elizabeth Warren stood as the sharp break from the past. Biden was the front-runner, but fragile. Many of the strongest debate performers — Cory Booker, Amy Klobuchar, Pete Buttigieg and Michael Bennet — couldn’t get any traction because Biden occupied the moderate lane. By the time he faded, it was too late.

Warren triumphed over the other progressive populist, Bernie Sanders, because she had what he lacked — self-awareness. She could run a campaign that mitigated her weaknesses. He could not.

Biden was holding on until Warren took Iowa and New Hampshire. He or some other moderate could have recovered, but the California primary had been moved up to March 3, Super Tuesday. When Warren dominated most of the states that day, it was over. The calendar ensured that the most progressive candidate would win.

Many pundits predicted that Warren was too much the progressive regulator in chief to win a general election. Indeed, her personal favorability remained low. But the election was about Trump — his personal disgraces but also the fact that he told a white ethnic national narrative that appealed only to a shrinking segment of the country.

Warren won convincingly. The Democrats built a bigger majority in the House, and to general surprise, won a slim Senate majority of 52 to 48.

After that election, the Republicans suffered a long, steady decline. Trump was instantly reviled by everyone — he had no loyal defenders. Only 8 percent of young people called themselves conservatives. Republican voters, mostly older, were dying out, and they weren’t making new ones. For the ensuing two decades the party didn’t resonate beyond its white rural base.

The American educated class celebrated the Warren victory with dance-in-the-street euphoria. In staffing her administration, she rejected the experienced Clinton-Obama holdovers and brought in a new cadre from the progressive left.

The euphoria ended when Warren tried to pass her legislative agenda. One by one, her proposals failed in the Senate: Medicare for all, free college, decriminalizing undocumented border crossing, even the wealth tax. Democratic senators from red states, she learned, were still from red states; embracing her agenda would have been suicidal. Warren and her aides didn’t help. Fired by their sense of moral superiority, they were good at condemnation, not coalition-building.

When the recession of 2021 hit, things got ugly. The failure of two consecutive presidencies had a devastating effect on American morale. It became evident that the nation had three political tendencies

  1. conservative populism,
  2. progressive populism and
  3. moderate liberalism.

None of them could put together a governing majority to get things done.

Before Warren, people thought of liberals and progressives as practically synonymous. After Warren, it was clear they were different, with different agendas and different national narratives.

Moderate liberals had a basic faith in American institutions and thought they just needed reform. They had basic faith in capitalism and the Constitution and revered the classical liberal philosophy embedded in America’s founding. They inherited Abraham Lincoln and Frederick Douglass’s millennial nationalism, a sense that America has a special destiny as the last best hope of earth.

Progressives had much less faith in American institutions — in capitalism, the Constitution, the founding. They called for more structural change to things like the Supreme Court, the Electoral College and the basic structures of the market. Trump’s victory in 2016 had served for them as proof that racism is the dominant note in American history, that the founding was 1619, not 1776. They were willing to step on procedural liberalism in order to get radical change.

With the Republicans powerless and irrelevant, the war within the Democratic Party grew vicious. Progressives detested moderate liberals even more than they did conservatives. The struggle came to a head with another set of Democratic primaries in 2024.

The moderate liberals triumphed easily. It turns out that the immigrant groups, by then a large and organized force in American politics, had not lost faith in the American dream, they had not lost faith in capitalism. They simply wanted more help so they could compete within it.

By 2030, progressive populism burned out as right-wing populism had. The Democrats became the nation’s majority party. This party ran on a one-word platform: unity. After decades of culture, class and demographic warfare, moderate liberals defined America as a universal nation, a pluralistic nation, embracing all and seeking opportunity for all.

In a wildly diverse nation, voters handed power to leaders who were coalition-builders not fighters. The whole tenor of American politics changed.