Now Warren has announced that she will be putting out her health-care plan in the next few weeks. While I have no inside information to confirm this, I’m fairly sure that it took so long because she and her team have been trying to figure out how to thread the needle on what may be an impossible problem, one with both policy and political implications. It’s hard to see how she’ll solve it.
Up until recently, Warren had seemed open to multiple approaches to achieve universal coverage and control costs. Although she co-sponsored Bernie Sanders’s single-payer plan in the Senate, she also co-sponsored other, more modest proposals (that’s true of other candidates, including Sanders himself).
But eventually Warren began speaking more firmly about her support for Medicare-for-all. Even if it’s a term with various definitions, she made clear her belief that insurance companies are at the center of what ails the system. They extract billions in profits while adding no value to anyone. And they do it, as Warren often points out, by collecting as much as possible in premiums and paying out as little as possible in claims.
At a different time, those ideas might still have left flexibility to take a number of approaches. The problem Warren faces is that within the Democratic Party, what used to be a lefty proposal — the creation of a widely available public option resembling Medicare or Medicaid — has now become the conservative position. The candidates espousing it — Joe Biden, Pete Buttigieg, Amy Klobuchar — are now attacking Warren from the right.
A couple of years ago, Warren could have said, “I support Medicare-for-all, which is why we should create a public option now, and over time, more people will migrate to it from private insurance. The transition will be less disruptive than if we did it all at once.” That wouldn’t have been seen as contradictory.
But now, saying that — especially since it’s basically what Buttigieg says — would be seen as a sellout and a flip-flop. Warren has seemingly been trapped into proposing something more closely resembling Sanders’s plan, not just by what she has said but by the way the rest of the field has moved.
That’s what happened to Kamala D. Harris. She’d said some of the same things as Warren about insurance companies. But when she released her plan — which would allow private insurers to compete with a government plan and so essentially universalize Medicare as it is now and not as it is in Sanders’s enormously generous vision (which is “Medicare-for-all” in the same way a Lexus LC500 is a Toyota Corolla) — it was greeted with contempt from the right and the left.
Warren could face the same problem. About a year and a half ago, Democrats all started saying they wanted Medicare-for-all, but they were using the term to refer to both single-payer and public option plans. Then pollsters began asking about it, and it turned out public option plans are much more popular.
The most important reason for this is loss aversion — people are afraid of losing what they have even if they’ll get something better in exchange and react positively to choice. There are plenty of arguments as to why single payer is actually superior, but few believe the public will grasp the nuances.
Before, the political advantages of public option plans weren’t clear. Now they are. That’s Warren’s dilemma: How can she offer something true to what she has said until now and doesn’t open her up to attacks that prey on the public’s fear of losing their insurance?
I honestly have no idea. But meanwhile, let’s keep a couple of things in mind.
The first is that the media’s incessant focus (and that of a couple of the candidates) on whether taxes will be raised on the middle class to fund Medicare-for-all is utterly inane. The whole point is moving from a system in which trillions of dollars are shunted through insurance companies to one in which that money moves through the government — minus what the insurance companies take for themselves.
When Warren says that what matters is the cost people pay and not whether it goes toward taxes or premiums, she’s exactly right. According to the Peterson-Kaiser Health System Tracker, the typical family of four with employer-sponsored coverage now spends $12,500 a year on health care, plus $1,450 in Medicare taxes, plus $13,050 that their employer contributes, for a total of $27,000 dollars in total costs.
The idea that it would be somehow worse to pay more in taxes while paying less in premiums and co-pays is both absurd and dishonest.
The second is that that we in the media judge Democrats and Republicans by wildly different standards when evaluating this kind of policy proposal. Donald Trump’s 2016 health-care plan consisted of “Everybody’s going to be taken care of, much better than they’re taken care of now.” It was gibberish, but the media pretty much let it slide.
Even before its release, Warren’s plan is being treated as though cost is the only thing that matters. But the far more important questions include: How will this work? What will the effects be on providers? How long will the transition be? How does Warren plan to overcome the opposition of wealthy interests? What will it mean for our economy and quality of life when everyone is covered and no one ever has to fight with an insurance company again?
Those are the questions we should be asking. I hope she has some good answers.