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The Question NBC’s Debate Moderators Should Ask Elizabeth Warren on #MedicareForAll

Summary:
By Lambert Strether of Corrente Despite Warren’s protestations that she supports Medicare For All, she has been, to put matters as kindly as possible, “vague about how to achieve it.” That, plus her camaign staff’s virtual radio silence on the policy, has created confusion about whether she supports the policy at all, even in seasoned observers like Matt Taibbi: [T]he observation about the Democratic race that’s sure to be relevant when real bullets start flying in primaries is that Democratic voters are in schism: there is a corporate-funded, centrist wing and an oppositional/anti-corporate/anti-war wing. Warren has smartly marketed herself as having a foot in both camps. She may very well prove a unifying figure — if that is possible, given how fierce the resistance would inevitably be

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By Lambert Strether of Corrente

Despite Warren’s protestations that she supports Medicare For All, she has been, to put matters as kindly as possible, “vague about how to achieve it.” That, plus her camaign staff’s virtual radio silence on the policy, has created confusion about whether she supports the policy at all, even in seasoned observers like Matt Taibbi:

[T]he observation about the Democratic race that’s sure to be relevant when real bullets start flying in primaries is that Democratic voters are in schism: there is a corporate-funded, centrist wing and an oppositional/anti-corporate/anti-war wing.

Warren has smartly marketed herself as having a foot in both camps. She may very well prove a unifying figure — if that is possible, given how fierce the resistance would inevitably be to any real attempt to reorganize the banking, pharmaceutical and tech industries. A lot will depend on how much credibility she’ll muster with hardcore progressive voters, some of whom are already grumbling, for instance, about her unwillingness (to date) to confront the health sector via Medicare-for-All.

Jacobin comments, in “Elizabeth Warren Has a Plan for Everything — Except Health Care“:

Warren’s avoidance of the issue is shocking. Health care repeatedly polls as the most important issue to voters — 80 percent told Gallup recently it’s “extremely” or “very” important to their vote. This is no surprise, as nearly 30 million Americans lack health insurance, and those who have it face prohibitive out-of-pocket costs and the ever-present fear that their employer will throw them off of their plan. The system is a colossal mess, and Americans are desperate for a solution. The majority of voters (as many as 85 percent of Democrats and 52 percent of Republicans) support Medicare for All for this very reason.

To be fair to Warren, that a candidate could say “I support Medicare for All” — as Warren often, but not always, says — and not necessarily have that mean “I support Medicare for All” is partly down to deliberate brand confusion by liberal Democrats, who hope to achieve their policy goal of preserving the health insurance industry as a donor class by labeling gimmicks like Neera Tanden’s Medicare Extra or the “public option” as “Medicare for All.” Nancy Pelosi says it best:

When most people say they’re for Medicare-for-all, I think they mean health care for all.

In this post, I’ll provide five reasons to believe that Warren does not, in fact, support Medicare for All, despite what she says. But I will conclude — plot twist! — with a new reason (at least new to me) to believe that she does. As the headline suggests, I think the way to get Warren’s stance clarified is to ask some probing questions in the upcoming debate next week.

1. Warren Has No “Plan” for #MedicareForAll on Her Campaign Site

As Gaius Publius points out, Warren’s “plan”-heavy campaign site provides no plan for #MedicareForAll, and indeed no plan for heatlh care generally. Here is the only verbiage I can find:

As the wealthiest nation in the history of the world, we can make investments that create economic opportunity, address rural neglect, and a legacy of racial discrimination–if we stop handing out giant tax giveaways to rich people and giant corporations and start asking the people who have gained the most from our country to pay their fair share.

That includes an Ultra-Millionaire Tax on America’s 75,000 richest families to produce trillions that can be used to build an economy that works for everyone, including universal childcare, student loan debt relief, and down payments on a Green New Deal and Medicare for All. And we can make a historic investment in housing that would bring down rents by 10% across America and create 1.5 million new jobs.

Leaving aside the fact that Federal taxes don’t fund Federal spending, #MedicareForAll is just one of a list of programs, with no details provided. That seems odd for a campaign that has crafted its candidate’s image as a virtuoso of policy details.

And here’s the first Google hit on ‘”medicare for all” site:elizabethwarren.com’ at the campaign site:

The Question NBC’s Debate Moderators Should Ask Elizabeth Warren on #MedicareForAll

Really? I grant it’s only the blog, but… really?

2. Warren Downplays #Medicare on the Campaign Trail

Here is a description of a recent campaign swing from the Des Moines Register:

On a two-day swing through eastern Iowa this week, Warren dug deep into at least three of her proposals — providing free child care and preschool for children up to 5 years old and increasing wages for child care providers, building 3.2 million new units to address the affordable housing crisis, and her latest, eliminating student loan debt and making college free for every student…. Warren finds it second-nature to consider detailed policy one of the most important aspects of a presidential campaign, said Jon Donenberg, the campaign’s national policy director. She’s spent her career as a professor researching the financial pressures facing middle class families in America.

“For her, talking about ideas and how to fix these problems is the reason to run for president,” Donenberg said. “Her ideas make her a credible agent of change.”

(We will have more to say about Donenberg below.) All laudable programs, and none of them #MedicareForAll, which (reviewing the Gallup poll) 80% of Americans support. “Two-thirds of people who file for bankruptcy cite medical issues as a key contributor to their financial downfall.” Bankruptcy law and policy was Warren’s academic field. Donenberg says Warren wants to address “the financial pressures facing middle class families.” So isn’t the silence on #MedicareForAll proposals rather curious?

3. Warren Recycles Typical Liberal #MedicareForAll Verbiage Designed to Create Brand Confusion

Warren, in a really sycophantic interview with Ezra KleinMR SUBLIMINAL Get a room!, says this: “Medicare-for-all, that fight that [sic] matters to me.” From her CNN Town Hall, here’s how (and I have to quote this in its entirety, so you can see the liberal Democrat brand confusion at work):

Asked about “Medicare for All” at CNN’s town hall Monday night, Sen. Elizabeth Warren suggested that she was open to multiple paths to universal coverage.

“When we talk about Medicare for All, there are a lot of different pathways. What we’re all looking for is the lowest cost way to make sure that everybody gets covered,” Warren said.

The Massachusetts senator then voiced several ways to achieve universal coverage:

Lowering the age: “Some folks are talking about, let’s start lowering the age. Maybe bringing it down to 60, 55, 50. That helps cover people who are most at risk.”

Increasing the age: “Some people say do it the other way. Let’s bring it up from — everybody under 30 gets covered by Medicare.”

Employer buy-in: “Others say let employers be able to buy into the Medicare plans.”

Employee buy-in: “Others say let’s let employees buy into the Medicare plans.”

Expanding Medicaid: “I’ve also co-sponsored other bills including expanding Medicaid as another approach that we use.”

“For me what’s key is we get everybody at the table on this,” Warren emphasized.

She later added: “But what’s really important to me about this is we never lose sight of what the center is. Because the center is about making sure that every single person in this country gets the coverage they need and that it’s at a price that they can afford.”

(“At a price they can afford.” Oh, look. Co-pays, deductibles, and gatekeepers!)

This is not “support” for #MedicareForAll, even if Warren did co-sponsor Sanders’ bill[1]. Think of it this way. You’re a barista, and you have a customer, and your customer says: “I’d like a latté, except maybe an espresso, or an Americano. Or a plain coffee. A plain coffee is a path to a latté, isn’t it?” Does your customer know what they really want? If they do know, are they telling you?

4. Warren’s Own Health Care Plan Was Not #MedicareForAll

From Pete Peterson’s Fiscal Times in 2018, “Elizabeth Warren Has New Plan to Improve Health Care – and It Isn’t Medicare for All

Warren on Wednesday introduced a new health care bill — and unlike the Bernie Sanders bill that Warren still co-sponsors, it does not call for a single-payer system. Instead, the legislation, called The Consumer Health Insurance Protection Act, aims to make insurance within the existing Obamacare system more affordable and protect more enrollees from insurance company policy changes and premium hikes. It would increase federal subsidies for people buying Affordable Care Act plans, allow more people to qualify for ACA tax credits and impose tighter controls on private insurers. Health policy expert Charles Gaba calls Warren’s bill, and similar House legislation that was introduced recently, “ACA 2.0.”

Of course, anybody can make a mistake, and politicians get to evolve. Oddly, or not, the press — with the notable exception of critical thinkers like Taibbi — seems to have allowed Warren to morph smoothly from an ACA 2.0 advocate to a #MedicareForAll advocate without questioning the reasons for the change. Given Warren’s propensity for “talking about ideas and how to fix these problems,” isn’t her (putative) evolution on health care policy worth a little scrutiny?

5. If “Personnel is Policy,” the Warren Campaign Opposes #MedicareForAll

As Warren says: “I’ll say the same thing publicly that I’ve said privately — personnel is policy.” (There doesn’t seem to be a listing of Warren’s policy shop anywhere; Ballotpedia lists only campaign staff. Readers, if you know of such a list, please leave it in comments. I went with what I could find with the usual search tools.)

As an overview, Warren has an enormous staff, especially for this stage of an election. From WGBH:

What separates [Warren] from other presidential candidates in the crowded 2020 Democratic field are the dozens of organizers, researchers, designers, media professionals, and operations aides she’s already put on staff. They are hard at work every day making the voter impressions and laying the groundwork that could pay off when Democrats ultimately decide who has earned their support.

Many are located in the campaign’s Boston headquarters, but Warren also has a virtual army of 50 staffers in Iowa, where the critical caucuses are nearly 10 months away, and smaller numbers populating other early-voting states.

And yet, none of these personnel have produced an evident work product on #MedicareForAll, or indeed on health care.

Now let’s look at three individuals who wear policy hats (at least some of the time) and are close to Warren. (Again, I took this approach because I couldn’t turn up an official health care advisor for the Warren campaign on health care.( For each, I’ve done a Google search on their names and “medicare for all”/”health care” and come up (almost empty). Because Twitter is an important interface between campaign professionals and the press, I also searched there, with the same result.

Dan Geldon. Geldon is the most important figure, being very close to Warren and the chief of staff for her 2020 campaign. From the Boston Globe, “Dan Geldon is Elizabeth Warren’s secret weapon“:

Geldon helped [Warren] run her 2012 Senate campaign — and also managed to get married during it. People involved in the campaign say he served as Warren’s voice at every meeting, ensuring the entire operation was consistent with the values that had made Warren a national figure.

“He was kind of the moral compass of the campaign,” said Doug Rubin, a senior strategist for that bid. When her election victory returned them to Washington, Geldon served as deputy chief of staff, and was closely involved in episodes that showcased their commitment to advancing their causes, even if it meant annoying or even alienating fellow Democrats.

In 2014, they launched an extended effort to get the Obama administration’s Department of Education to crack down on for-profit colleges, combining a loud and public campaign with aggressive private outreach, instead of the polite back-channeling that is customary between political allies in government.

Later, Warren unleashed the power of her formidable grass-roots following to sink Obama’s nomination of Wall Street banker Antonio Weiss to a top Treasury position.

The successful attack on the Democratic administration reflected one of Warren’s and Geldon’s, motivating principles, that “personnel is policy.” There was other evidence it worked: During the 2016 race, Hillary Clinton and her campaign operatives sought input from Warren and Geldon on their picks for economic advisers.

But Geldon has nothing to say on #MedicareForAll. Here are the results of a Twitter search, in their entirety:

The Question NBC’s Debate Moderators Should Ask Elizabeth Warren on #MedicareForAll

Jon Donenberg. Donenberg is senior adviser and policy director to Warrens’s 2020 campaign. From Time:

Jon Donenberg, senior adviser and policy director to the senator’s 2020 campaign, tells TIME Warren’s detailed ideas are extensions of who she’s always been and what she’s long been fighting for.

“Elizabeth’s bold ideas are a natural extension of her life’s work fighting to reverse the economic squeeze on working families,” he said. “Her commitment to big, structural change is credible because it is supported by an agenda of serious, specific and aggressive reforms to get our economy, our government and our democracy working for everyone — not just the wealthy and the well-connected.”

All very fine, but Donenberg has nothing to say on #MedicareForAll either (despite having written for the Yale Law Journal on health care policy). Here is the Twitter search:

The Question NBC’s Debate Moderators Should Ask Elizabeth Warren on #MedicareForAll

Ganesh Sitaraman. Sitaraman served as Policy Director to Elizabeth Warren during her successful Senate campaign, and then as her Senior Counsel in the United States Senate (after which he became a Senior Fellow at CAP). During that time:

During the campaign and in the Senate, Sitaraman’s work spanned an extraordinary range. “I worked on a variety of policy issues—health and education, foreign policy, banking and finance, energy and environment.

However, Sitaraman has nothing to say about health care today, and he isn’t even on the Twitter:

The Question NBC’s Debate Moderators Should Ask Elizabeth Warren on #MedicareForAll

However, Sitaraman has co-authored a book on the “public option” as a generic policy tool. So we can see where that goes.

If indeed personnel is policy, it’s hard to see how the Warren campaign does anything other than give #MedicareForAll lip service.

And Yet…. Warren Just Endorsed Massachusetts Bill H1194, “An Act Establishing Medicare for All in Massachusetts”

And now the plot twist. As it turns out, Warren supported a Medicare for All bill in the Massachusetts House just last week. From Stephanie Murray in Politico, this:

Sen. Elizabeth Warren and Sen. Ed Markey will submit written testimony to the Joint Committee on Health Care Financing today, their offices confirm, as the committee considers a series of health insurance bills. On the docket are several bills that aim to establish a so-called single-payer health care system in Massachusetts.

(I don’t know what that “so-called” is doing there.) Now, we’ve already seen that there’s brand confusion about Medicare for All, and we’ve also seen Warren crawfishing in her CNN interview to that effect, so we need to look more deeply at Politico’s reporting. Let’s start with the “docket” or agenda:

The Question NBC’s Debate Moderators Should Ask Elizabeth Warren on #MedicareForAll

As you can see, Lindsay N. Sabadosa has introduced H.1194, “An Act establishing Medicare for all in Massachusetts,” in the Massachusetts House. (James B. Eldridge introduced the companion Senate bill, S.683.) Note also that if you compare the agenda to Warren’s crawfishing on CNN, there are several bills that could be construed as being “Medicare for All” besides H.1194/S.683. So, two questions. What words did Warren use to “support” Sabadosa’s bill? And is Sabadosa’s bill really single payer Medicare for All? Let’s take each in turn.

Here, Warren tweets her support:

Ugh. “Quality, affordable” is liberal Democrat bafflegab for ACA 2.0, and “lend my support to their fight” isn’t the same as “fighting for” (even if you buy the shopworn “fight for”MR SUBLIMINAL and never win trope).

However, Warren’s written testimony — available as of this writing only (!) as a screen shot on Stephanie Murray’s Twitter feed — is far less equivocal:

The Question NBC’s Debate Moderators Should Ask Elizabeth Warren on #MedicareForAll

Not ugh. There’s none of the crawfishing language, health care is a right, and it’s Warren’s fight too, not just Sabadosa’s. Also, and importantly, several of the other bills on the agenda provided “paths to” #MedicareForAll (assuming that you believe this formulation is ever made in good faith). But Warren endorsed only Sabadosa’s bill. I find that encouraging.

Is Sabadosa’s bill single payer? The Daily Hampshire Gazette:

The bills filed by Sabadosa, Garlick and Eldridge would would make it state policy to provide access to health care services to all residents as a right, “without co-insurance, co-payments or deductibles,” through a new Massachusetts Health Care Trust.

Any federal health care funds and revenues from a 7.5 percent employer payroll tax, a 2.5 percent employee payroll tax, and a 10 percent tax on self-employed payroll and unearned income would go into the trust. The first $30,000 in payroll for employers and the self-employed would be exempt, and employers with 100 or more workers would face an additional tax of 0.44 percent.

I can’t say whether a Trust is a good idea or not. However, I did look at the bill:

Section 20. Funding Sources.

(a) The Trust shall be the repository for all health care funds and related administrative funds. A fairly apportioned, dedicated health care tax on employers, workers, and residents will replace spending on insurance premiums and out-of-pocket spending for services covered by the Trust.

And:

Section 21. Insurance Reforms.

Insurers regulated by the division of insurance are prohibited from charging premiums to eligible participants for coverage of services already covered by the Trust.

I welcome the interpretations of more cynical readers. However, it looks to me like Section 20 nukes the insurance companies, and that Section 21 makes sure (as in Canada) that if single payer covers a service, the health insurance companies cannot.

Conclusion

Of course, Warren endorsed the Sanders Bill for #MedicareForAll (S.1129). And after she did, she went and spouted all that nonsense on CNN. So her support for Sabadosa could be just as equivocal as her support for Sanders (though, again, Warren made a strong statement when the agenda gave her every opportunity to make a weak one)[2]. I think the moderators of NBC’s forthcoming Democratic Presidential Debate should put Warren on the spot and clarify her stance. Perhaps this question would do the trick:

Q: Senator Warren, given your unequivocal support just last week for Massachusetts bill H.1194, “An Act establishing Medicare for All in Massachusetts,” is passing Senator Sanders’ bill S.1129, the “Medicare for All Act of 2019,” which you co-sponsored, your objective for the American health care system? And if you have other plans, will you put them on your campaign site?”

Readers, feel free to improve on this question!

NOTES

[1] Jayapal’s bill is better.

[2] She could also be sandbagging the left, especially those who make #MedicareForAll a litmus test.

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