Elizabeth Warren unshackles herself from 'Medicare for all'

Elizabeth Warren has committed herself to a huge, government-run health plan that would eliminate private insurance, even though voters don’t like the cost or the tradeoffs. But the presidential contender has now rolled out a “transition” to ‘Medicare for all’ that would be less disruptive and more palatable to voters.

Warren’s transition plan would allow anybody over 50 to pay to join Medicare, with free coverage for all kids under 18 and anybody earning less than 200% of the federal poverty level, which is around $51,000 for a family of four. The Democratic senator from Massachusetts hasn’t estimated the cost of this expanded coverage, but she said previously she’d pay for Medicare for all with new wealth taxes on families with fortunes of $50 million or more and new business taxes. Businesses, in theory, would end up no worse off because their new taxes would be equal to or less than what they’re already spending to provide health care for employees.

The key difference with Warren’s new transition plan is she’d leave private insurance in place, which makes it comparable to plans offered by Joe Biden, Pete Buttigieg and other more moderate Democrats running for president. She would also strengthen the Affordable Care Act, which borrows from Biden’s commitment to improve the plan that went into effect when he was Barack Obama’s vice president.

The Biden and Buttigieg campaigns both blasted Warren’s pivot to a transition plan, charging her with trying to obscure her desire to dismantle private insurance. The Biden campaign called it “a full program of flips and twists.” That’s a preview of how Warren’s opponents will attack her evolution on health care—and also a sign they may view the change as a new threat.

Under Warren’s transition plan, eligible workers with employer-based coverage could choose the government system instead, though most would have to pay for it. Warren thinks they would, because it would offer a better deal. By her third year in office, Warren says, “The number of individuals voluntarily remaining in private insurance would likely be quite low.”

That’s the point at which she’d make her move toward a full single-payer program that would eliminate private insurance, by proposing legislation that would be able to pass the Senate with a simple majority instead of the supermajority required under filibuster rules. Her bet is that newly available government insurance will have become popular by then, essentially gutting the private market. But that would only happen if people could get affordable care without long waits for services, one of the biggest risks of a government-run system.

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Warren now acknowledges that drawback, too. She says her transition plan would pay doctors and other caregivers more than Medicare rates, to prevent an exodus of caregivers finding their paychecks slashed under a full government plan. To prevent doctor shortages as millions of additional patients seek care, Warren would push reforms such as providing more money for residencies, letting nurses and physician assistants perform more routine care and creating more incentives for caregivers to serve rural and low-income areas.

The changes in Warren’s plan are politically shrewd. Up till now, she’s been advocating a plan with a very unpopular side effect: killing private insurance. Alan Abramowitz of the University of Virginia’s Center for Politics pointed out recently that Democrats who supported Medicare for all in the 2018 midterms did worse than those who did not. He described Medicare for all as a “vote loser.”

As Warren has risen in the polls to front-runner status, analysts have wondered whether she’d pivot away from Medicare for all if she won the Democratic nomination. Now we know. She’s got Medicare for all to pitch to more liberal Democratic primary voters and a less radical transition plan as a fallback. She can play up one or the other, based on the leanings of her audience. Her odds of winning the Democratic presidential nomination may just have gone up.