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How Elizabeth Warren has stayed out of the Medicare-for-all fray

Elizabeth Warren has a plan — to avoid getting bogged down in the Medicare-for-all fight.

Sen. Elizabeth Warren, right, speaks at the third Democratic debate while Sen. Bernie Sanders, left, and former Vice President Joe Biden look on.
Win McNamee/Getty Images
Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

Elizabeth Warren has been walking a tightrope for months on Medicare-for-all and yet, unlike some of her competitors for the 2020 Democratic presidential nomination, she hasn’t really stumbled yet. Instead, she seems to have found her footing.

Last week, the Massachusetts senator laid out her plan, such as it is, for health care. She embraced single-payer Medicare-for-all (no real surprise as she is a cosponsor of Bernie Sanders’s bill), calling it “the best way to give every single person in this country a guarantee of high-quality health care.”

But what stood out, for a campaign built on her love of plans and details, was that her health care agenda didn’t hit many specifics for how she would implement Medicare-for-all. She didn’t talk about an implementation timeline (like Kamala Harris) or explain how to pay for it (as Sanders has tried to do). She supports Medicare-for-all because she thinks it is the best way to give every American health care; let’s talk about the details later.

”It is in some ways off-brand for Sen. Warren not to have a detailed health plan of her own,” says Larry Levitt, senior vice president at the Kaiser Family Foundation, a health care research group.

Warren is a Rorschach test for Democrats on health care. Diehard Sanders supporters have been criticizing her for a while for not releasing her own plan for single-payer health care and for ducking some of the more difficult questions about how to set up such a system. Releasing her plan last week didn’t seem to do much to assuage their concerns.

Center-left wonks, on the other hand, were initially cheered by her perceived flexibility about the next steps for health reform — Warren had previously said that there were many paths to universal coverage — but they are now feeling dismayed about her unreserved praise for Medicare-for-all and Sanders’s plan specifically. Jonathan Chait at New York magazine lamented last week that Warren had “handcuffed herself to the Sanders plan.”

There may be a method to the madness. Warren has managed to split the difference by embracing the progressive position — “I’m with Bernie,” as she said at one of the debates — but she has not made health care a point of emphasis in the same way that Sanders does. She has said unequivocally that her anti-corruption plan would be her top priority as president, and she took her time in rolling out even the semblance of a health care plan. In doing so, she has avoided some of the difficult questions that have plagued Kamala Harris throughout her campaign.

You could argue it’s a copout, as the most ideologically committed on the left might. You could argue it’s misguided, as the center-left would.

But Warren has found a comfortable space in between two poles. The health care debate for now is really between Sanders on the left and Biden in the center — most of the tit-for-tat at last week’s debate was between those two — and Sanders himself does not seem particularly interested in challenging Warren’s commitment to the Medicare-for-all cause. He didn’t go after her last week, now that they were finally sharing the debate stage, instead focusing on Biden and the more incremental proposals from other Democrats.

Warren has made some radical health care proposals of her own, such as a plan to have the federal government manufacture (or contract a private entity to manufacture) generic drugs in the event of egregious price hikes. But she seems intent on staying above the Medicare-for-all fray that has dominated so much of the Democratic primary campaign to date.

And Warren has proven adept at parrying away the attack lines from debate moderators and the moderates. Biden tweaked her about the finances for Medicare-for-all to lead off last week’s debate, but Warren found a way to justify her position without getting into a protracted confrontation with Biden.

So, let’s be clear about health care. And let’s actually start where [the] vice president did. We all owe a huge debt to President Obama, who fundamentally transformed health care in America and committed this country to health care for every human being. And now the question is, how best can we improve on it? And I believe the best way we can do that is we make sure that everybody gets covered by health care at the lowest possible cost. How do we pay for it? Those at the very top, the richest individuals and the biggest corporations, are going to pay more. And middle class families are going to pay less. That’s how this is going to work.

She deftly pays homage to Obamacare in one breath, embraces Medicare-for-all in the next and then makes a simple fiscal case for it: the elite pay more, the middle class pay less. She doesn’t disparage the moderate position, as Sanders would a few moments later, but she makes a pocketbook case for ambitious reform.

If she seems less committed to the cause than Sanders, who “wrote the damn bill,” it’s not clear that Democratic voters are holding that against her. There is some competitive polling on this question; some suggests Dem voters want Medicare-for-all now, other surveys indicate the party’s base is okay with incremental reforms. I keep coming back to this CNN poll from June in which half of Iowa Democrats said supporting Medicare-for-all was a must-have for their 2020 candidate and roughly half said it wasn’t.

Warren has potentially found a way to satisfy both of those constituencies: embrace Medicare-for-all, but don’t make it the cornerstone of the campaign. That’s her plan — for navigating the Democratic primary, anyway.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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