Annie Linskey
November 15, 2019 at 7:01 p.m. CST
After months of criticism from Democratic leaders and voters, Sen.
Elizabeth Warren offered a new approach to her Medicare-for-all proposal
Friday, adding an intermediate step that would let Americans participate in an
optional government-run health plan before she attempted to pass a mandatory
program.
Under Warren’s new plan, which she calls a “Medicare for All option,” all
Americans would be eligible to participate in Medicare, but no one would have
to. She would push for this initiative in her first 100 days in the White
House, then make a separate effort to pass Medicare-for-all later in her first
term.
It’s a clear shift for the senator from Massachusetts as she attempts to
ward off criticism that her single-payer health plan is unrealistic
substantively and toxic politically. Warren for months had signaled a
full-throated embrace of Medicare-for-all, and this new approach significantly
tempers that urgency.
That may ultimately better position Warren for a contest with President
Trump if she is the Democratic nominee. But on Friday it prompted an immediate
backlash from her centrist rivals as well as liberal activists.
Kate Bedingfield, deputy campaign manager for former vice president Joe
Biden, called Warren’s maneuvering “a full program of flips and twists,” while
Sen. Michael F. Bennet (D-Colo.) said she was “backtracking,” and Lis Smith,
spokeswoman for South Bend, Ind., Mayor Pete Buttigieg, accused her of trying
to “paper over a very serious policy problem.”
On the left, activists sounded the alarm that Warren’s two-step approach
could halt momentum for Medicare-for-all, potentially torpedoing that goal.
“Doing this in stages creates a political danger and an opening for
opponents to prevent further progress,” said Adam Gaffney, president of
Physicians for a National Health Program. “The longer the rollout, the more
political risk.”
But Warren suggested that her approach was the best of both worlds,
providing immediate relief for many Americans without giving up the goal of a
universal, government-run program.
“By the end of my first 100 days, we will have opened the door for tens of
millions of Americans to get high-quality Medicare for All coverage at little
or no cost,” Warren wrote in a Medium post. “But I won’t stop there. Throughout my term, I’ll fight
for additional health system reforms.”
She said she hopes voters will be able to “see for themselves” that their
experience with Medicare is better than with private insurance, building
support for Medicare-for-all.
Experts and rivals portrayed the move as a retreat from one of Warren’s
highest-profile policy positions on a matter that’s of top importance to many
voters. Her position arguably now resembles the “public option” favored by many
of her centrist competitors: a proposal that would allow Americans to choose a
government-run program if they wanted, rather than the mandatory approach
favored by Sen. Bernie Sanders (I-Vt.).
“It’s much less disruptive,” said
Kenneth Thorpe, a health-care expert at Emory University. “It’s in the same
spirit as offering a public option.”
Sanders, accepting an endorsement Friday from the largest nurses union in
the country, attacked Warren’s approach as a postponement in the fight against
a rapacious health-care industry. “Some people say we should delay that fight
for a few more years — I don’t think so,” he said. “We are ready to take them
on right now, and we’re going to take them on on Day One.”
Warren’s team is particularly sensitive to how Sanders’s voters perceive
her proposal, since she hopes to pick up their support should he drop out of
the race.
“Fundamentally, the question that will prove the wisdom or the failure of
the whole calculation is: Is she still close enough” to Sanders?, said one
person familiar with the Warren campaign’s thinking, who spoke on the condition
of anonymity because they were not authorized to discuss details of the
campaign.
“If she’s the nominee — or if people
have to decide to rally between one of the two of them — has she stayed close
enough that people think, ‘It’s not exactly Bernie, but it’s pretty darn
close’?”
Medicare-for-all has become a major test for Warren, who has steadily risen
in the polls after a rocky start. As her candidacy has gained momentum, she’s
faced increasing scrutiny over how she’d pay for the program without raising
middle-class taxes.
Leaders in her own party have also questioned whether she could withstand
attacks in a general election accusing her of eliminating the private health
insurance industry and taking insurance away from more than 150 million
people.
Those concerns deepened this
month when Warren proposed a $20.5 trillion financing plan for
Medicare-for-all, mostly in the form of new taxes. Critics said it would result
in a tax hike on the middle class — something she denied — while academics said
her cost assumptions were far too optimistic.
Warren’s team carefully laid the groundwork for Friday’s proposal, reaching
out to selected allies, which paid off in some quarters. Ady Barkan, an
influential advocate for Medicare-for-all, said the transition plan is “smart
politics and good policy.”
Rep. Pramila Jayapal (D-Wash.), who introduced the House version of a
Medicare-for-all bill, called it
a “smart approach.”
Centrist Democrats’ angst over Warren’s momentum is one reason why former
New York mayor Mike Bloomberg is considering entering the presidential race and
why former Massachusetts governor Deval Patrick recently launched his candidacy.
Patrick, on his first full day campaigning Thursday, contrasted Warren’s
health-care approach with his.
“We kept learning as we went, and I think that’s what’s going to have to
happen for any of the big solutions,” he said, recalling how Massachusetts
officials expanded health care in the state. “I want us to have an ambitious
agenda. I want that. That is the goal. The means for getting there can vary.”
Warren’s transition proposal is similar to the plan Buttigieg has outlined,
which he calls “Medicare for all who want it.” Under that idea, Medicare would
be open to the poor and would provide subsidies to middle-income families.
“This is definitely Warren inching over toward Buttigieg and away from
Bernie on health care,” opined Nate Silver, editor in chief of the politics website
FiveThirtyEight.
Warren has provided more details than Buttigieg, saying she would
immediately offer free health care to about half the country, including all
children and poor families. She would also lower the eligibility age for
Medicare to 50 and let young people buy into “a true Medicare for All option.”
The person close to Warren’s campaign said she had not expected
Medicare-for-all to become such a critical issue in the presidential race. In
the early spring, all the major Democratic contenders aside from Biden signaled
support for it, but a backlash has prompted several candidates to back away.
“It wasn’t really clear that we were going to be spending the fall drilling
down on the details of her [health-care] plan,” said the person close to
Warren.
“They wanted to make sure they were stapling themselves to
Medicare-for-all,” the person said. “But it wasn’t clear that there was going
to be much more to it then advocating for Bernie’s plan.”
Jeff Stein and David Weigel contributed to this report.
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