Our spring issue, “Pandemic Politics,” is out now. Get a discounted subscription today!

Riding the Fence on Medicare for All Isn’t Smart Politics

With Kamala Harris out of the race and Elizabeth Warren’s numbers dropping, recent weeks haven’t been kind to candidates who have equivocated on Medicare for All. Bernie Sanders is the only candidate whose support for M4A is solid and unchanging — a stance that’s not only morally correct but politically smart.

Alex Wong / Getty Images

It’s been a tough few weeks for Democratic presidential candidates who’ve equivocated on Medicare for All.

Most strikingly, earlier this week, Sen. Kamala Harris’s presidential campaign died on the vine. The major obstacle preventing Harris’s campaign from ever achieving liftoff was that she built her career from prosecutor to city district attorney to state attorney general as a tough-on-crime Democrat in California. In the post–Black Lives Matter era (and one in which leftist Twitter users were constantly calling her a cop, which apparently bothered campaign staffers), the image Harris had cultivated became a political liability.

But the public’s trust in Harris was shaken for another reason: her flip-flopping on Medicare for All.

Harris announced her candidacy on a Friday in January 2019. On the next Monday, she suggested at a CNN town hall event that she agreed with Sen. Bernie Sanders — whose 2017 Medicare for All bill she co-sponsored — that all private health insurance should be eliminated and replaced with a universal public program.

“I believe the solution, and I actually feel very strongly about this, is that we need to have Medicare for all. That’s just the bottom line,” she said. Referring to the private health industry, she added, “Let’s eliminate all of that. Let’s move on.”

Strong stuff. But facing intense criticism for these remarks from billionaires like Howard Schultz and Michael Bloomberg, Harris’s campaign immediately recanted. By the end of Tuesday, her campaign press secretary and a top adviser had both assured the media that Harris was open to keeping private insurance.

Her campaign had been in swing for only five days, and she already blatantly backtracked on Medicare for All. It wouldn’t be the last time.

In June, Harris told the New York Times that she did support scrapping private health insurance. On the debate stage later that week, she raised her hand alongside Sanders to affirm that position. Then, less than twenty-four hours after the debate, Harris walked it back again, insisting that she misunderstood the question as being about which option she would select personally, not her plan for the entire country.

By July, she had released a health-care plan of her own, disingenuously called Medicare for All, that retained a role for private insurance — a complete reversal of her previous stated commitments.

At that debate in June, Harris workshopped a new tagline. She would pursue what she called a “3 a.m. agenda,” a raft of “tangible solutions to the issues that wake us up in the middle of the night.” But the real Kamala Harris 3 a.m. agenda, it appeared, was fielding phone calls from incensed deep-pocketed supporters in the wee hours and issuing an embarrassing retraction at daybreak.

Harris’s prosecutorial background no doubt limited her appeal from the outset. But her poll numbers didn’t actually begin to plunge with the circulation of Kamala-the-cop memes in the spring; they dropped precipitously in the summer, following her second public reversal on Medicare for All.

Future historians won’t be able to tell the story of Kamala Harris’s ill-fated presidential campaign without accounting for her wild vacillations on the election’s highest-profile political issue, based on her campaign’s (ultimately incorrect) read of what was politically advantageous rather than morally right.

Warren’s Fancy M4A Footwork

Grabbing fewer headlines this week was Sen. Elizabeth Warren’s recent dip in the polls. In September, Warren was hailed as the race’s new front-runner after a surge in support that month. But any front-runner has a target on their back, and her opponents quickly found her weak spot.

While Warren had avowed support for Sanders’s Medicare for All plan since her campaign launch, she tended to elide details, either referring people to Sanders’s plan without getting into the weeds herself or reducing Medicare for All to a “framework” that lacked specifics. And there was one detail in particular that she was clearly uncomfortable embracing: the inevitability of a middle-class tax hike.

Sanders has been consistent on this point, clearly explaining that a few people’s taxes will go up, but overall costs will go down, while claims denials and medical debt will become a thing of the past. But for her part, when asked if she would raise taxes, Warren assiduously avoided this direct explanation.

On the debate stage in October, Pete Buttigieg, whose “Medicare for All Who Want It” plan amounts to a public option with a continued role for private insurance, accused Warren of evasiveness on the tax question. Warren responded that under her plan, taxes “will not go up for middle-class families. And I will not sign a bill into law that raises their costs.”

Without attacking Warren, Sanders then responded by separating taxes and costs: even if taxes go up, costs will go down. “The tax increase they pay will be substantially less — substantially less than what they were paying for premiums and out-of-pocket expansions,” he said.

A moderator asked Warren, “Will you acknowledge what the senator just said about taxes going up?” She would not.

Sensing an opening, Sen. Amy Klobuchar, who herself opposes Medicare for All, went for the jugular. “At least Bernie’s being honest here and saying how he’s going to pay for this and that taxes are going to go up,” Klobuchar said. “And I’m sorry, Elizabeth, but you have not said that, and I think we owe it to the American people to tell them where we’re going to send the invoice.”

To many viewers, on both sides of the Medicare for All debate, it appeared that Warren had something to hide.

Her campaign quickly realized the error and announced that they would be releasing their own financing plan, one that would corroborate Warren’s claims that Medicare for All could be achieved without a middle-class tax hike. Unfortunately, the plan they released only made matters worse.

Clearly Warren’s campaign had hoped that the media would declare her victorious in solving the puzzle. At first a few did. But as the details were fully debated, many onlookers — again, on both sides of the Medicare for All debate — were left puzzled.

To avoid looking like she was raising taxes on the middle class, Warren proposed a regressive head tax on employers. An employer-side head tax is a tax, just a badly designed one that ends up shifting the cost burden to workers. Warren appeared to be seeking to obfuscate elements of Medicare for All that she considered a political liability in order to protect her own campaign from criticism, refusing to call a spade a spade.

One week later, Warren announced that she would not be fighting for Medicare for All at the beginning of her first term in office. Instead, she would pursue a public option — in other words, “Medicare for All Who Want It.” Once that was won, she insisted, people would realize that they did in fact want it, and this would make it easier to fight for Medicare for All. It’s the same logic Buttigieg uses when he talks about the public option as a “glide path” to single-payer health care.

Both proponents and opponents of Medicare for All interpreted Warren’s two-step strategy as a pre-compromise. And in the middle were plenty of voters unsure what to think about Medicare for All, but who came away with the perception that Warren, though less clumsy and obvious than Harris, was likewise grasping for the most politically expedient position.

And, as with Harris, the triangulation that was intended to avoid scaring off key constituencies ended up depressing enthusiasm overall, because it undermined the notion that she was engaged in a forthright, honest effort to win a health-care reform in which she truly believed. Any explanation of Warren’s recent waning support that fails to account for the damage this did to her campaign is incomplete.

Give It to Me Straight

If the health and lives of millions of Americans weren’t at stake, you’d have to feel sorry for these candidates. Most of the Democratic presidential field — with one rumpled, finger-wagging, politically and morally unshakable exception — are caught in a bind when it comes to public health insurance.

On the one hand, Medicare for All is popular, particularly among Democratic voters. On the other, the health insurance companies, hospitals, pharmaceutical companies, billionaires, and the entire Republican Party are waging all-out war on the prospect. That’s a tricky spot to be in, unless you’ve held the conviction for over four decades that corporations should not under any circumstances be allowed to continue raking in billions in annual profit by denying people care, overcharging for medicine, and maintaining health care as a lucrative commodity rather than a basic right for all people.

American voters aren’t stupid. They can tell the difference between candidates who are ironclad supporters of a policy because they believe it’s the right thing to do, and candidates who are calibrating their message to avoid criticism and please as many people as possible.

The public’s attraction to political conviction runs the other way, too. Pete Buttigieg is rising in the polls, and Joe Biden maintains his lead. One thing these centrists have in common: they both oppose Medicare for All and aren’t coy about it. In the end, this helps them in a way that’s similar to how a commitment to Medicare for All helps Sanders. A lot of voters who are attracted to Medicare for All are unsure what to think about its feasibility. But they’re still planning to vote, and they’re more inclined to throw their support behind a candidate who appears to give it to them straight.

Electorally, it’s unwise to equivocate on the biggest issue of the cycle. Morally, it’s indefensible to support the continued existence of the private health insurance system, which exists to deny people coverage while extracting as much profit from them as possible in their time of need. There’s only one candidate who’s both consistent and correct on this question. That’s Bernie Sanders.

Harris is out. But even though her front-runner title has currently been revoked, Warren remains very much in the game. She’ll likely continue to straddle the divide between a public option and a single-payer Medicare for All program for the time being — but don’t expect that to work in her favor.

While the American public has yet to be fully convinced that Medicare for All is an achievable fix to our health-care system, it knows the system needs fixing. And, one direction or the other, it’s most likely to follow a candidate who knows where they’re headed.