Elizabeth Warren has nominally thrown her support behind the idea of Medicare for All, a proposal that has enjoyed growing popular support since Bernie Sanders put it on the map in 2016. But fearful of a right-wing backlash, Warren is hesitant to echo Sanders in saying that the program will raise taxes. Her refusal has left many scratching their heads about how she plans to pay for single-payer health care.
At the most recent Democratic Party presidential debate, the moderators repeatedly asked Warren if Medicare for All would impose a tax increase on ordinary families. She responded each time with various iterations of her prepared remark: “I will not sign a bill into law that does not lower costs for middle-class families.”
Her supporters praised her for not giving the Right a sound-bite to manipulate, but it’s not clear the evasion worked in her favor. “At least Bernie is being honest here, and saying how he’s going to pay for this and that taxes are going to go up,” responded Amy Klobuchar. “And I’m sorry, Elizabeth, but you have not said that and I think we owe the American people to tell them where we will send the invoice.”
It’s true that Sanders has been more upfront about the role of taxes in funding Medicare for All. In a recent interview on Jimmy Kimmel Live, Kimmel said, “I think you are very blunt and brutally honest, almost to the point where it’s shocking to see a politician say ‘Yes this is going to make your taxes go up, but in the big picture I think that it will make it cost you less.’” Sanders agreed with that assessment, and explained the mechanism: because people will no longer be paying premiums, deductibles, co-pays, or any out-of-pocket costs, health care costs will go down for the vast majority of people even as their taxes go up. Health insurance will finally be universal, and medical debt will be a thing of the past.
Behind the scenes, it seems Warren’s campaign knows that her unwillingness to talk about tax increases is a weak spot. Warren is now rumored to be coming out with a plan of her own to finance Medicare for All in the coming weeks. The campaign has been tight-lipped about the details of the plan, which are likely still in the making, but outside economic advisers have suggested a variety of options. One idea is to cobble together the funds through business, sales, and other taxes. Another is to introduce a “public premium,” which is essentially a separate bill collected by the government and used to finance a public program — but don’t call it a tax.
“She wants something airtight but easy to understand,” one outsider told the Washington Post. But here’s the truth: the most airtight and easiest thing to understand is the idea of contributing taxes based on our ability to pay, to finance a system that covers everybody and lowers costs overall. Anything else is needlessly complicated. And choosing a complicated alternative out of fear of the word “taxes” is a massive concession to the Right. If the Left can’t explain why channeling progressive taxes into universal public programs is a good solution to an endemic social problem, we’re woefully unprepared for the fight to come.
Warren is probably overstating the threat of public disfavor if she follows in Sanders’s footsteps. Sanders has not found it difficult to explain that because healthcare ought to be a right, it is reasonable to expect that we should all pay what we can in order to furnish it for ourselves as a society. This is not a foreign concept to Americans. Generally speaking, it’s how we fund our public parks, our public schools, and our public libraries. Excitable libertarians aside, you rarely hear Americans complaining about the fact that their tax money goes to fund public fire departments — people understand that without them, the cost of protection from fire would be far greater on each individual, and chaos would ensue.
The concept of funding things collectively to make them cheaper and more reliable is not lost on most people, nor is it that difficult to explain. If the Right comes at us howling about tax increases, that’s to be expected, and can be countered with kitchen-table math. And if a politician can’t effectively explain why paying money into public coffers instead of private ones is going to cost less and be more effective — or is too scared of the Right to even attempt that explanation — then they’re ill-equipped to lead the charge.
Furthermore, there’s a value in progressive taxation to fund universal social programs that transcends dollars and cents, and it’s incumbent on left-wing politicians to recognize and communicate that value. Public programs are always vulnerable to austerity, and they need to be designed to withstand attempts at erosion. Everybody paying in what they can and receiving what they need creates a sense of collective responsibility and ownership over social programs — a sense of “This is ours, we provide it for ourselves” — and that makes them harder to take away.
Progressive taxation is therefore a politically smart way to design a universal social program. Additionally, it makes perfect sense to add this cost to the general tax bill instead of sending a separate bill (a “public premium”), which implicitly sets the service being rendered apart from the broad project of collectively sustaining a society we all want to live in. Paying for health care via taxes like all the other public and universal goods we enjoy enshrines it as a social right, which is necessary for the program’s success and longevity in the face of inevitable attempts at austerity.
It remains to be seen how Warren plans to square the circle. But whatever she comes up with, it won’t be any better than simply raising taxes in order to bypass private insurance, eliminate co-pays and deductibles and premiums, and lower costs overall for an essential service that will finally be available to everyone in their time of need. That’s the right way to do it.
In the end, we need to trust that people don’t care who they write the check to, as long as the number on it is smaller. And we need a leader who is capable of shooting down right-wing talking points with ease — not one who needlessly triangulates to avoid them.