In recent months, the Democratic presidential candidate Senator Elizabeth Warren has come under fire because of the high cost of her proposed Medicare for All health plan. It’s estimated to cost the country $20.5 trillion, twice the estimated amount of her other policy proposals. As The Atlantic’s Ron Brownstein wrote in November, that’s more than the federal government now spends on Social Security alone or Medicare and Medicaid combined. While Warren has said repeatedly that her plan won’t require tax increases on the middle class, it has nevertheless caused some sticker shock—even among others in her party.
Other Democratic candidates have attacked her over the plan’s likely cost during debates. Left-leaning health experts Brownstein interviewed said the plan requires “heroic” assumptions about the savings that can be wrung from America’s bloated health-care system. One vulnerable Colorado Democrat fretted to Politico that the health plan would cause “down-ballot damage” if Warren becomes the nominee. The plan’s massive cost—and the potential tax increases that would follow—has become Warren’s Achilles’ heel, a wild card for a candidate who otherwise seems to have everything planned out.
Last night, she sought to change all that. During a question about health care during the Democratic debate, Warren found a new way to describe her plan. It boils down to, essentially: Bigger is better. “The problem is that plans like [Mayor Pete Buttigieg’s] and [former Vice President Joe Biden’s], they are an improvement,” Warren said. “But they’re a small improvement. And that’s why it is they cost so much less.” The answer to her cost conundrum, she said, was to charge huge companies like Chevron and Amazon more in taxes.
It was a savvy way to reframe her greatest weakness as a strength. Rather than get spooked by a number like $21 trillion, she seemed to say, why don’t voters imagine how much therapy and medicine and knee-replacement surgery that money can buy—and consider sticking large corporations with the bill. And rather than reasonable moderates, it cast her opponents who don’t want Medicare for All—Buttigieg and Biden among them—as thinking too small. In a way, it portrays them as not courageous enough to try to give Americans really good (albeit expensive) health care.
Buttigieg, at least, seemed caught on the defensive. “We have to move past a Washington mentality that suggests that the bigness of plans only consists of how many trillions of dollars they put through the Treasury,” he shot back. (Buttigieg is the “outsider” from Indiana, thus the dig at Washington.) He added that his plan would also be big—“the biggest thing we’ve done for American health care in a half century.”
It will be interesting to see whether Warren is able to continue to push the narrative that a health-care plan’s cost is a measure of its ambition. Doing so would require quite the reeducation campaign. A slight majority of Americans now support Medicare for All, but they seem confused about what it would entail. According to some polls, for example, people think it means they would still get to keep their private health-insurance plans, which they likely would not. And having the option of keeping private health insurance, for now, seems more popular than being forced to scrap it.
Warren’s ability to win over health-care voters might depend on her ability to convince Americans that a major overhaul—even if extremely expensive—is actually better than fiddling around the edges. It would hinge on selling them a relatively un-American idea: that big government, along with its big health care, is good.
Perhaps Americans’ reluctance to part with private health insurance is simply a peculiarity of American health care, which has been so bad for so long for so many people that voters are anxious to hold on to what they already have, even if it’s not perfect. Incremental plans like Buttigieg’s and Biden’s can feel reassuring when you’re worried that the whole system might be blown up and made even worse. If there’s one thing we can hardly afford, it’s that.