When told that Joe Biden had criticized her Medicare-for-all plan for, among other things, levying $9 trillion in a new tax for corporations that would likely squeeze wages, Sen. Elizabeth Warren (D-Mass.) retorted: “Democrats are not going to win by repeating Republican talking points and by dusting off the points of view of the giant insurance companies and the giant drug companies." She also asserted that the former vice president and veteran member of the Senate was “running in the wrong primary.”

Well, it takes some nerve to write out of the party President Barack Obama’s vice president, House Speaker Nancy Pelosi (who last week warned about Medicare-for-all) and numerous Democratic lawmakers, as well as a flock of Warren’s competitors, ranging from Sen. Amy Klobuchar (D-Minn.) to Andrew Yang, who don’t want to get rid of private insurance either. Warren’s ideal Democratic Party is a very tiny Democratic Party, it seems. (This kind of answer, you’ll recall, got her in trouble in the last debate, when both Klobuchar and South Bend, Ind., Mayor Pete Buttigieg pushed back on the notion that only Warren cared about universal health-care coverage.)

Warren has to do better than this if she wants to convince voters that Medicare-for-all is more than rainbows and unicorns, and even more important, if she wants to present herself as someone to unify the party. Kicking a former vice president out on ideological purity grounds is a poor tactic.

The difficulty for Warren remains the substance of her plan. Appearing on ABC News’s “This Week," Buttigieg said: “What is just not true is that hers is the only solution. This ‘my way or the highway’ idea, that either you’re for kicking everybody off their private plans in four years or you’re for business as usual, it’s just not true.” He added: “I’m proposing Medicare for all who want it. Now, if we do that, that’s the biggest change in American health care in 50 years.” In his understated way, Buttigieg added in regard to Warren’s plan, “Well, the math is certainly controversial.” He added, “Again there are variations in the estimates in the trillions and trillions and trillions of dollars, and we don’t have to go there in order to deliver health care to everybody.”

The substance does pose a significant problem for Warren on several fronts, starting with the huge tax bill that comes with it, a super-charged IRS (with a fantastical claim that better enforcement gets us $3 trillion) and greater reliance on an implausible wealth tax (which has failed when tried in other countries, thanks to the ease with which the wealthy hide or transfer wealth). This is hardly a Republican talking point, as Rahm Emanuel, former Democratic mayor of Chicago and chief of staff for Obama, put it on Sunday. “Well, look, here’s the thing. She was drafting behind Bernie [Sanders],” he told George Stephanopoulos. “This was Bernie’s idea. And now she owns this idea. And what she did today is take it from a health care idea to a tax idea.”

At the heart of the debate is whether Warren has used smoke-and-mirrors calculations to disguise a reality that just about every independent analyst (and many Democrats) know: You cannot do this without hitting the middle class. Ron Brownstein points out:

Warren’s estimate is considerably lower than most projections for a single-payer system, as her team acknowledged in its own analysis of the plan. Even at a flat $20 trillion, such a plan would cost more than the federal government now spends on Social Security alone or on Medicare and Medicaid combined. ...
That gap matters so much because it probably determines whether a single-payer plan can be financed without raising taxes on the middle class, as Warren has pledged. The financing proposals she outlined Friday did not directly hit middle-class taxpayers, but those provisions wouldn’t come close to covering the full cost of her plan if the actual price tag is closer to those other studies’ estimates.

In other words, is Warren being straight with voters or simply trying to get out of a jam she created for herself when she hopped on Sanders’s Medicare-for-all bandwagon to protect her left flank?

Warren is also terribly cavalier about the impact that her plan has on working- and middle-class people. Asked what all the health-care insurance company workers would do if their business was outlawed, she blithely said they could go work in other areas of insurance — as if thousands upon thousands of jobs are waiting to be filled with refugees from health-care insurance companies.

Part of her scheme for keeping the cost down is her unrealistic assumptions about the amount of cost she can wring out of doctors, hospitals and drug and device manufacturers. A co-author of the Urban Institute study tells Brownstein, “We are talking about very sizable average decreases across the country in what hospitals are being paid. . . .We thought 115 percent [of Medicare] was pretty aggressive and optimistic.” (Warren offers 110 percent.) You can squeeze hospitals and doctors as much as you want, but some will close up shop, skimp on patient time, and lay off or cut wages of nurses and technicians (and other middle- and low-wage earners).

It is not simply that Warren’s math strains credulity; it is that she seems willfully ignorant of the consequences of the actions she supports to get to those numbers. It will be up to Democrats who favor much more reasonable plans to make the case that hocus pocus proposals do real damage to the effort to obtain important, winnable improvements in our health-care system.

Left-wing populism that promises painless solutions to vastly complex problems sets voters up for disappointment, erodes credibility in government and spreads the same kind of cynicism that comes from proposals such as President Trump’s mythical health-care plan that was going to be so much better than Obamacare. Maybe it is time to treat voters like adults and get back to the business of legislating in the real and messy political circumstances in which we operate.

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