Elizabeth Warren is being fundamentally dishonest about Medicare for All. Not just vague. Not just evasive. Not just dodgy. Dishonest.
At last night's Democratic primary debate, Warren repeatedly refused to admit something that is obviously true: that Medicare for All, the single-payer health care plan envisioned by Sen. Bernie Sanders (I–Vt.) that Warren says she supports, would require higher taxes on most Americans, including the middle class.
We know that this is true because the plan would, according to multiple independent estimates as well as Sanders himself, cost somewhere in the range of $30 or $40 trillion over a decade. (A new estimate of the type of plan that Warren and Sanders support puts the cost at just a hair over $34 trillion.) That's $30 or $40 trillion in new government spending, on top of the federal spending that would have occurred otherwise. And as Sanders—who likes to remind people that he "wrote the damn bill"—has said on many occasions, that means higher taxes. Sanders has not proposed tax revenues that are sufficient to cover the cost of his plan. But he has, at least, been clear that higher taxes are part of the deal.
Warren, pushed at last night's debate to acknowledge what even Sanders admits, declined. Instead, despite attacks from rival candidates Pete Buttigieg, Sen. Amy Klobuchar (D–Minn.), and former Vice President Joe Biden, she stuck firmly to a canned talking point about "costs."
"We can pay for this," she said at one point. "I've laid out the basic principles. Costs are going to go up for the wealthy. They're going to go up for big corporations. They will not go up for middle-class families."
Warren's answer isn't just designed to avoid answering the question; it is designed to mislead.
"We can pay for this," she says, yet the Sanders plan, as written, does not raise sufficient tax revenue to cover the massive new federal spending it would require. "I've laid out the basic principles," she says, yet aside from a broad statement that costs will go up for corporations and the wealthy, but not the middle class, she has proposed nothing that would provide even the most general sense of how she would finance a single-payer system. The "basic principles" she has laid out are vague to the point of total uselessness.
Warren's defenders, and supporters of Medicare for All, have insisted that the awkwardness of her answer is merited by the disingenuousness of the underlying question. What most people care about, this argument goes, is total costs, not taxes. That's why Warren avoids directly answering the question: What matters, in this view, is that under Medicare for All, total health care costs for the nation and for most families would go down. That's what Bernie Sanders says, in his own way, and that's what Warren is attempting to get across.
This is a fair defense of Warren in the sense that it accurately captures the heart of Warren's talking point. The problem is that there is good reason to believe that her talking point is wrong, or at the very least debatable.
Instead of lowering total national health care spending, one estimate found that the Sanders plan—the plan that Warren supports—would increase total health care spending by more than $6 trillion. That figure comes from a 2016 analysis of the plan by the Urban Institute, a reputable liberal think tank. Warren can't simply dismiss this as a right-wing talking point.
The same goes for another analysis of Medicare for All, by Emory University health policy scholar Kenneth Thorpe.
Thorpe's estimates of an earlier iteration of the Sanders plan found that more than 70 percent of people who now have private insurance—the majority of Americans with health coverage—would pay more in taxes than they would save. Thorpe also found that the Sanders plan had estimated more annual savings on prescription drugs than the U.S. spends in a year, meaning that prescription drug spending would literally have to be negative.
The Sanders camp revised that figure in response, but the essential features of the plan have stayed largely the same. And Thorpe remains skeptical of the way proponents of Medicare for All have described the plan: "Obviously, all of the 180 million people who have private insurance are not going to pay less. It's impossible to have an 'everybody wins' scenario here," he recently told The Washington Post, later adding: "There's no question it hits the middle class,"
Thorpe isn't some predictable conservative critic. He's not even a longtime liberal skeptic of single-payer: In 2006, he laid out a proposal for a single-payer plan for Bernie Sanders' home state of Vermont. Yet his estimates indicate that, contrary to Elizabeth Warren's promises, health care costs for the middle class would go up.
Yes, other estimates have found that total spending might go down. But at minimum, it's far from clear what would happen, especially since Warren has provided so few details about what she wants to do. And the idea that taxes would go up by quite a lot is far from a fringe position. As University of Chicago economist Katherine Baicker recently told The Washington Post, "Most of the proposals to move to Medicare-for-all would involve substantial tax increases that would affect most people."
This is what Warren won't say. Instead, she is leaning on a dubious talking point designed to avoid the plain truth that taxes will go up under the plan she supports. She isn't trying to inform the public about the nuances of an academic debate. She isn't being straightforward. She has settled on a response that has been calculated to mislead for political gain.
In doing so, she has opened herself up to substantive attacks from her rivals, and undermined the core argument of her presidential campaign. Warren has presented herself as a kind of wonk populist whose mastery of policy detail and ability to communicate complex ideas are among her key strengths. Her campaign is structured around the idea that she knows exactly what she's doing—and that, as a result, you can trust her. What Warren made clear at last night's debate, and what she has proven over and over again on the campaign trail, is that only the first part is true.