The decommodification of health insurance was always an anomaly in Elizabeth Warren’s liberal reform agenda. After all, Warren famously called herself a “capitalist to my bones.” But after months of cryptic rhetoric, she has reconciled this inconsistency with a health care plan that won’t get us closer to achieving Medicare for All.
Warren’s recently unveiled health care plan asks us to park the demand for Medicare for All for three years in favor of pushing for a public option. Instead of replacing private insurers with a single-payer system, a public option is a publicly run health care plan that would compete against private insurers on the Affordable Care Act (ACA) exchanges.
Warren calls her iteration of this idea a “Medicare for All option,” distinguishing it from past public option proposals by including more generous coverage and automatic enrollments. She claims that her “Medicare for All option” will be funded “without raising taxes on the middle class by one penny.” The financing blueprint combines regressive taxes with highly contingent revenue streams such as passing immigration reform, ramping up IRS enforcement, and eliminating Pentagon slush funds.
Framing the public option as a transitional demand, Warren maintains that her long-term goal is still achieving Medicare for All. She argues that a public option will be easier to pass in Congress than a single-payer system. Once passed, it will generate support from its recipients and weaken insurance companies’ “ability to frighten the American people,” therefore enabling us to succeed in achieving Medicare for All in the second half of her term.
Whatever her intentions, Warren’s reversal from Medicare for All to a public option will sideline our movement — and fail to move us closer to achieving either program.
The Public Option Will Not Transition Us to Medicare for All
First, it’s important to get one thing straight: the public option is not an incremental step toward Medicare for All.
Despite its distinctly generous terms, Warren’s Medicare for All option will be unaffordable to many who fail its means test. If a family of four makes more than $51,000 a year, they will be deemed to have the “means” to pay premiums and co-pays. That falls well below the median household income in America of $63,179. If you’re on traditional Medicare, Warren will cap your out-of-pocket costs at $1,500 a year. For the one in three senior households with either no money left over each month or debt after meeting essential expenses, this is nowhere near adequate.
No matter where you set the bar of deserving and undeserving, means-testing is a breeding ground for resentment toward those who qualify from those who don’t — the kind of politics the Right thrives on and has mobilized in recent decades alongside neoliberal Democrats to completely shred the social safety net. In contrast, Medicare for All’s commitment to universal health care free at the point of use would build solidarity by improving the lives of all working people.
On top of failing to be truly universal, Warren’s public option wouldn’t cut costs. Adam Gaffney, president of Physicians for a National Health Program, predicts that a public option will burden the government with the sickest and costliest patients, effectively subsidizing the continued profits of private insurers. Only a single-payer system can contain costs by controlling drug prices and reining in administrative overhead.
Means-tested and expensive, her public option is likely to backfire — and as a result, turn people against Medicare for All. Meanwhile, private insurance companies will be left fully intact to lobby against it.
Now Is the Time for Medicare for All
According to Warren, we must pump the brakes on Medicare for All because our movement won’t have the power to beat back insurance companies in her first term. It’s not clear if Warren truly expects passionate Medicare for All activists to heed this call. Single-payer activist Ady Barkan — despite recently endorsing Warren — was absolutely right when he told the New Republic that winning Medicare for All would require “a truly enormous grassroots movement, and that only exists for Medicare for All. No one is gonna get arrested for the Public Option Choice Act of 2021.”
Warren fails to appreciate that thousands of people are already getting involved in politics through campaigns for Medicare for All. They constitute the beginnings of exactly the kind of movement we’ll need to win.
Activists have built momentum with statewide single-payer campaigns in California and New York. We have passed dozens of city council resolutions, including Bethlehem, Pennsylvania and Los Angeles, California just last month. We have bird-dogged dozens of politicians. We’re rallying outside the offices of representatives.
A few weeks ago, nurses staged a massive die-in outside Rep. Nancy Pelosi’s office demanding that she bring the legislation to a vote. Organized labor is stepping up in the South. DSA is running insurgent candidates for Congress like Heidi Sloan, who cut her teeth on her local Medicare for All campaign in Austin. Since Sanders’s 2016 run, activists have spearheaded countless canvasses, town halls, direct actions, and letters to the editor.
And it’s working. Against opposition, support for Medicare for All among a majority of Americans has risen since Sanders’s run and remains steady. As of this year more than half of all House Democrats support Medicare for All. We’ve flipped key congress members like John Yarmuth in Kentucky, Lloyd Doggett in Texas, Ben Ray Luján in New Mexico, Hakeem Jeffries in New York. The first hearing in the bill’s history featured a powerful testimony, and the bill has moved through more critical hearings since then with another next week.
Postponing Medicare for All until we cinch every vote ignores the fact that like all historic reforms, achieving it could take multiple sessions of Congress. With that in mind, the goal of bringing legislation to the floor right now should not be confined to winning a majority vote. The goal must also be to expose where representatives stand so that our movement can hold them accountable.
Unlike Warren, Sanders will force a vote. He has promised to introduce Medicare for All in the first week of his term. If Democratic senators choose to defy a presidential mandate and side with private insurance companies, then they will have to make that choice in front of the American people.
But that’s not his entire strategy. Sanders has focused his entire political life on empowering ordinary people by getting them involved in the political process. For him, the growth of the Medicare for All movement is the growth of a political revolution that will transform our country. Instead of tamping down popular militancy in the name of pragmatism, Sanders promises to scale up our mass organizing to an unprecedented level. As he put it this year:
I’m going to run the presidency differently than anyone else. I’m not only going to be commander-in-chief, I’m going to be organizer-in-chief. We’re going to rally the people. . .to tell their senators to stand with ordinary Americans and not with wealthy campaign contributors.
Don’t Fall for It
Unfortunately, some activists in positions of leadership have fallen for the bait and switch. Barkan, one of the highest-profile Medicare for All advocates (with good reason), endorsed Warren following the release of her plan, which he hailed as “the greatest feat of public policy jujitsu that I have ever seen.”
But there are serious ideological and tactical differences between the candidates and looking at responses helps us separate the wheat from the chaff. After sizing up her plan, it’s clear that Elizabeth Warren doesn’t care about passing Medicare for All. Any hope of keeping Medicare for All on the agenda in the foreseeable future will be made or broken with Bernie Sanders. Those who are serious about winning must rally our movement behind his campaign while we can.