Harris and others who have decided against full-blown Medicare-for-all should be commended, not ridiculed as “small thinkers” for eschewing an enormously costly and choice-averse concept at a time Americans want discrete, concrete things (e.g., low drug prices). By listening to experts and voters, watching poll numbers and thinking strategically about how to beat Trump, Harris likely made the best political decision, long-term, for her campaign. There are good policy and political reasons to wind up where she did.
First, Medicare-for-all is totally unnecessary. If you give people the option of selecting Medicare, then all the problems described by proponents of Medicare-for-all go away. Those people won’t get surprise bills. They won’t have to hassle with insurance companies. They won’t have to work about escalating premiums. By telling voters they cannot even have the choice, Sanders and Warren channel the liberal stereotype of people who don’t allow others to make their own decisions, even ones the two senators insist are obvious.
Second, Sanders and Warren have yet to grapple fully with the cost. Shouldn’t someone with a revolutionary plan to change the face of health insurance tell us in detail how much it will cost and who is going to pay? This is not simply a quaint affection for fiscal sobriety. If the price is outlandishly high, then the idea is never going to happen, supporters should fess up. Moreover, the bigger the price tag, the more obvious it is how many people will have taxes raised. Who exactly? By how much? It seems highly unusual that Warren, who’s got a well-thought out proposal for everything, hasn’t thought through the full ramifications of her most controversial proposal.
On the political front, Warren and Sanders are now wrestling for the votes of the most progressive voters. Biden’s poll numbers to date, however, suggest a candidate aiming for a wider ideological coalition in the primary can do just fine, and quite possibly win. That becomes even more true as the race gets down to the final three to five candidates. Why try to out-Sanders and out-Warren the two Medicare-for-all proponents when the winner could very well be Biden or the person prepared to scoop up Biden voters if and when he falters?
And finally, a nominee who avoids Medicare-for-all makes it that much easier to oust Trump. Plenty of voters are tired of gigantic, unfulfilled promises to reinvent the Affordable Care Act, which they’ve finally figured out and like. (Thanks to Trump, the ACA still draws close to majority support.) You shift the health-care debate back where it should be: Trump tried to take away health care once; if reelected, is there any doubt he’ll do it?