"The idea that the next Democratic president could pass a major public option bill and then, perhaps after the 2022 midterm elections, be in a position to pass actual Medicare for All is just not tenable. It's just not."
While Sen. Elizabeth Warren received praise from some high-profile Medicare for All proponents after the 2020 Democratic candidate released a detailed "transition plan" on Friday, progressive critics of the proposal openly worried the proposal reveals gaps in her commitment to the goal of universal healthcare, a naivety about the political fight needed to get there—or both.
"There is no way the fight for single payer would survive Warren's plan. It is practically tailor-made to divide, depress, marginalize, and exhaust any political will for single payer before we've even begun the final fight."
—Carl Beijer, writer and activistUnder the new proposal, Warren will work to establish during her first 100 days in office what she calls a "Medicare for All option" that would allow any American who wants to participate in Medicare, the ability to do so. Following that successful effort, and alongside other reforms—including pushing anti-corruption reforms, lowering drug costs, and repairing the damage to the existing Affordable Care Act by President Donald Trump—Warren says she would then initiate a separate effort to pass Medicare for All legislation later in her first term.
While the initial stages of the transition she proposes would take place over the first half of her term, Warren said in statement that "no later than my third year in office," she will begin the "fight to pass legislation that would complete the transition to full Medicare for All."
Read the complete plan here. Warren also released the following video to explain her approach:
Top Medicare for All proponents like dying activist Ady Barkan and Rep. Pramila Jayapal (D-Wash.)—who introduced the "Medicare for All Act of 2019" in the U.S. House in February—praised Warren's plan as a serious effort to address concerns about how to transition from the current system to a single-payer model.
"Warren's transition plan," tweeted Jayapal on Friday, "reaffirms her commitment to the four-year transition plan outlined in the Senate Medicare For All bill. It lays out how she'd use executive and administrative authority to take on for-profit insurers and begin providing relief to the American people on Day 1."
But progressive critics skeptical of Warren's plan, including writer and activist Carl Beijer—author of a piece published by Jacobin magazine Saturday titled "Elizabeth Warren's New Health Care Plan Would Doom the Fight for Medicare for All"—the transition timeline proposed is a key indicator that the Senator from Massachusetts is either not in it to win it or grossly miscalculates what a delayed implementation of Medicare for All will mean. According to Beijer:
It is perfectly obvious to anyone who thinks about this for five seconds how it would actually play out.
During the first "legislative push," Republicans would argue that Warren's first bill is a radical communist government power grab doomed to dysfunction and failure—and single-payer activists would be backed into either abandoning the project or insisting that yes, the public-private plan is actually quite reasonable and good. This would
- Split the movement along entirely predictable lines that are completely familiar to left organizers — "let's work with Democrats" versus "we must hold the line";
- Undermine the commitment and investment of activists who have reluctantly decided to support a bill that is at odds with what they think really needs to happen with health care in the United States;
- Center Warren's first plan as the "reasonable" compromise, and the second plan as an unnecessarily radical instance of Democrats pressing their advantage; and
- Exhaust everyone before picking the second fight.
"There is no way the fight for single payer would survive Warren's plan," writes Beijer. "It is practically tailor-made to divide, depress, marginalize, and exhaust any political will for single payer before we've even begun the final fight."
Beijer was far from alone in his critique.
splitting this bill into 2, and only passing the M4A part 3 years in, is insane. if the next president gets to pass… https://t.co/J1YsfIneM5— ryan cooper (@ryan cooper)1573836146.0
Elizabeth Warren retreated from Medicare-for-all today. That’s what happened.— Walker Bragman (@Walker Bragman)1573864025.0
Will Menaker, one of the co-hosts of the popular left-wing podcast Chapo Traphouse, pulled no punches in his response:
It's Game Over on the question of whether Elizabeth Warren supports Medicare for All, we can stop arguing about it… https://t.co/dyAr9jvijU— Will 🦥 Menaker (@Will 🦥 Menaker)1573839656.0
Also critical of the proposal was The New Republic staff writer Libby Watson who explained that Warren's proposal is essentially a "plan to pass a public option before pivoting to single-payer" after several years—a strategy, she warned, that "is too clever for its own good."
"If Warren believes that what's possible is limited to a public option, she should just say so."
—Libby Watson, The New RepublicAccording to Watson, Warren has made a crucial mistake by allowing criticisms of bad-faith Republicans—and attacks on Medicare for All from within her own party from people like Nancy Pelosi, Joe Biden, and Pete Buttigieg—to constrain the public narrative about what is and what is not possible to achieve in the upcoming political battle over healthcare. Watson writes:
Democrats are often so bent on being clever that they end up somewhere incredibly stupid. Seeing the stranglehold that Republicans and the filibuster have put on the Senate, Democrats spend all of their time figuring out their strategy like it’s a puzzle to be solved, a game of chess that’s not worth playing unless success is pre-ordained. What currently passes for policy fights among Democrats boils down to the struggle to discover the magic point where compromise and passage become guaranteed, rather than developing the best possible policy and staking a claim to be the party that will resolve America's problems. The next Democratic president is going to have to fight very hard to pass anything worth passing, in any policy area—and even the best effort may not be enough. But allowing timid centrists and hostile Republicans to set the boundaries for what's possible locks in limited possibilities and sends a demoralizing message to the electorate.
If Warren believes that what's possible is limited to a public option, she should just say so. It would not be illegitimate for Warren to argue that she would rather support a compromise measure that she believes has a better chance of passing—though in that case, she will have to own the substantive inadequacies and diminished public health that arise from that decision. If, however, she actually wants to pass Medicare for All, leaving that project to her third year in office makes no sense—unless the plan is to create an escape hatch from her promise of single-payer. There are two possibilities: Either Warren is naive, or she believes voters to be.
"The idea that the next Democratic president could pass a major public option bill and then, perhaps after the 2022 midterm elections, be in a position to pass actual Medicare for All is just not tenable," tweeted Osita Nwanevu, Watson's colleague at TNR. "It's just not."
Put next to the approach of Sen. Bernie Sanders, the other top-tier candidate who supports Medicare for All, Beijer argues that Warren's transition proposal is an instructive example of what distinguishes the two. "Sanders understands that this is a political fight, and that’s why he insists on settling this in one bill—an approach that stands the best chance of keeping the public mobilized," Beijer wrote. In contrast, he added, and "for all her technocratic savvy," Warren "has badly misunderstood the political problem at hand."
While the Sanders campaign did not address or criticize Warren's proposal directly over the weekend, a tweet sent out Friday afternoon offered a veiled contrast in terms of the kind of priority passing a full Medicare for All bill would get from a Sanders administration and that delaying its implementation would not be part of the strategy.
"In my first week as president," the candidate tweeted, "we will introduce Medicare for All legislation." He later made the same announcement during a press conference with National Nurses United, who officially endorsed Sanders on Friday, and again at the California Democratic Convention on Saturday.
During his event with the NNU, Sanders said, "With National Nurses United at my side, during the first week of our presidency, we are going to introduce the legislation that will bring Medicare for All to everyone in this country."