Montana Gov. Steve Bullock, who knows something about winning over purple voters, began the night by warning against running on “wish-list economics.” Former congressman John Delaney, who used to represent a marginally Democratic district in Maryland, argued that Democrats must recall the hard-learned lessons of the past: Run too far left and the Democrats would fail like Walter Mondale in 1984 and Michael Dukakis in 1988. Former Colorado governor John Hickenlooper pointed out that the candidates who wrested control of the House from Republicans last year ran in the middle; they did not promise a Sanders-Warren agenda.
Warren dismissed these warnings as “small ideas and spinelessness.” Sanders insisted that Democrats should settle for nothing short of “an unprecedented grass-roots movement to not only defeat Trump but to transform our economy and our government.” As though merely defeating the worst president in U.S. history were not the chief and overriding goal.
But arguments about what will sell in a general election are only so compelling. It is not just that the Sanders-Warren platform is out of step with the middle of the country; it is that it is bad on the merits. The knockout blow came when the health-care plan at the center of their agenda failed to withstand the scrutiny of the other candidates.
South Bend, Ind., Mayor Pete Buttigieg argued that immediately revoking everyone’s private insurance and replacing it with a public plan would be disruptive and unnecessary — even if you want every American on a public plan. Let Americans choose, he argued: Provide universal access to a public plan, and allow Americans to vote with their feet. Eventually, if the wholly public system is superior, it will win out.
Favoring a “Medicare for all who want it” plan, Buttigieg argued, is not simply a political calculation — Republicans would call Democrats "crazy socialists" no matter what they proposed — but better policy. It is less coercive yet no less committed to attaining universal coverage.
The hardest punch came from Delaney. After Sanders insisted that his plan would provide better health care than even those with extremely generous union insurance plans currently enjoy, Delaney jumped in with a somewhat wonky answer that exposed the intellectual rot at the center of Sanders’s absurd over-promising: “The bill that Senator Sanders drafted by definition will lower quality in health care, because it says specifically that the rates will be the same as current Medicare rates. And the data is clear: Medicare does not cover the cost of health care, it covers 80 percent of the costs of health care in this country. And private insurance covers 120 percent. So if you start underpaying all the health care providers, you’re going to create a two-tier market where wealthy people buy their health care with cash” and everyone else, prohibited from choosing any other option, “will be forced into an underfunded system.” Hospitals would close. The country would risk a shortage of health-care providers. Sanderscare literally does not add up.
Sanders and Warren marshaled two arguments. First, they accused their critics of repeating Republican talking points, which is not a policy argument at all.
Their other defense was only marginally more substantive: that insurance companies are bad, profit in the health-care sector is bad, and health-care bureaucracy is bad. “Why does every doctor, why does every hospital have to fill out so many complicated forms?” Warren asked. “It’s because it gives insurance companies a chance to say no and to push that cost back on the patients.”
Of course, doctors and hospitals would still have to fill out forms under Sanders’s plan, just like they do now under Medicare. It’s just that they would exclusively bill the government. And the government would still deny care that some people wanted, because if it didn’t, the country would spend unsustainable amounts of money. Every system requires trade-offs, a simple fact that Sanders and Warren refuse to admit.
Their promise to End All The Bad Things is a fiction unbefitting the serious debate about health-care policy that the rest of the Democratic field is engaged in. Universal health care can work. Single-payer can work. Just not the way Sanders and Warren promise.
If there were any justice in politics, Delaney would be rising in the polls and Sanders and Warren would be relegated to the fringe. The only top-tier candidate onstage Tuesday who distinguished himself on health care — and, by extension, realism — was Buttigieg.