Back in 2017, Bernie Sanders introduced a Senate bill on Medicare for All. It’s hardly the first version of this proposal. John Conyers introduced a less detailed version of it in the House each term since 2003. But Sanders has done more than anyone else to popularize the idea in US politics. So much, in fact, that just about all the major Democratic presidential contenders hopped on board. Literally co-sponsoring the bill in the case of the senators running for president.
And that’s no exaggeration. Here’s a list of Medicare for All co-sponsors who ran for president: Cory Booker, Kirsten Gillibrand, Kamala Harris, and Elizabeth Warren. Let’s not forget several others also endorsed the proposal: Pete Buttigieg (!), Julián Castro, Tulsi Gabbard, Tom Steyer, and Andrew Yang.
But times get tougher when you’re running for president. It’s one thing to announce a bold agenda, but it’s another to defend that agenda during the invisible primary. Consequently, it’s time to ask which ones chickened out. Who pulled a flip-flip on Medicare for All?
What is Medicare for All?
One notable thing about the 2020 campaign is this. Some candidates play around with the phrase Medicare for All. So I’ll start by getting clear about what I mean by it. There are two Medicare for All bills in the current Congress: the Bernie Sanders Senate bill and the Pramila Jayapal House bill. Vox provides a pretty good overview of the Sanders bill and the Jayapal bill. I won’t repeat everything Vox has to say.
Here’s the gist of it. Medicare for All is a public health insurance program with a single-payer (i.e., the government), while health care delivery remains mostly private. Any proposal worth the name has the following features: a.) it’s one health insurance program administered by the federal government; b.) it provides comprehensive coverage, including dental, vision, mental health, and prescription drugs in addition to standard ‘health care’; c.) it’s free at the point of service (i.e., no copay or deductible); d.) it provides government insurance to everyone (i.e., it’s universal).
And that’s it. The DSA Medicare for All campaign provides a similar overview. And I basically follow DSA’s lead here. They add a fifth condition, namely a jobs and severance initiative for people who’d lose their current jobs with private health insurance companies. And that’s fine with me. I suspect any bill that actually passed would include a jobs provision, though I wouldn’t call this an essential feature of the program.
What Medicare for All Isn’t
One thing worth noting at the outside is what Medicare for All is not: it’s not a simple expansion of the current Medicare system to include everyone. The current Medicare system, while it works for lots of people, fails multiple conditions. Most notably, it’s not comprehensive and it’s not free at the point of service.
And so, any candidate peddling mere expansions of the current program to more people isn’t advocating Medicare for All.
Checklist: Did They Flip-Flop?
Cory Booker: Probably
Booker doesn’t really say much about health care these days. And with that, it’s worth starting with something of a tension involving all of these candidates (except, of course, Bernie Sanders). By endorsing Medicare for All, they endorsed a social democratic proposal. But none of them (except, again, Bernie Sanders) is a social democrat. And so, they’ve made a mess they’re now cleaning up.
That’s why we’re here in the first place with all this flip-flopping.
Now back to Booker. Why doesn’t he talk much about health care? Because he probably doesn’t really support Medicare for All. But we don’t know for sure. What we know is that he’s made comments supportive of private health insurance, suggesting he’s not on board with the universal nature of Jayapal-Sanders.
Pete Buttigieg: Yes
The Booty Judge wins the award for most outrageous flip-flop. Here’s what he had to say in 2018: “I, Pete Buttigieg, politician, do henceforth and forthwith declare, most affirmatively and indubitably, unto the ages, that I do favor Medicare for All, as I do favor any measure that would help get all Americans covered.”
Don’t believe he said that? Here’s the tweet.
Now, Buttigieg endorses ‘Medicare for All Who Want It’. Sounds like the same thing, right? But with more…freedom? What could be bad about that?
The trouble is that Buttigieg equivocates on ‘Medicare’. His public plan, which he calls ‘Medicare’, has practically nothing in common with the Medicare plan in the Jayapal and Sanders bills. It meets none of the criteria I listed earlier. In particular, it would include all of the various confusing features and extra charges (e.g., copays, deductibles, lack of dental and vision care, et al.) that plague the current plans offered on the Obamacare exchanges.
Ultimately, the rhetorical problem with the Buttigieg plan is that if people had the Jayapal-Sanders plan as an option, they’d all choose it. Thus, ‘Medicare for All Who Want It’ is either self-defeating or self-fulfilling. In other words, the Buttigieg plan is fucking horseshit. And gives us more reason to suspect he might be the worst candidate.
Julián Castro: Yes, with a ‘but’
Castro reneged sometime over the summer. He stated it most explicitly at the Iowa CCI Forum last month. While he wasn’t very clear on what he advocates, I think the basic idea is that he wants to expand the current Medicare system to more people while retaining some form of private system for at least a number of years.
But I think there are a couple of details to consider with Castro. First, his website still lists universal public health insurance as a goal. That puts him closer to Sanders and Warren than to the other candidates. On the other hand, Castro’s comments at the CCI Forum and the debates cast doubt on whether he’s serious about this goal. Especially in light of the fact that he’s been pretty weak for most of his political career.
But, second, Castro’s health care platform is a potential backup in the event of the failure of Medicare for All. Assuming a President Sanders or President Warren tries to get it passed and can’t, strengthening Medicare and gradually expanding it is probably the next best thing. Done properly, opening up the door to everyone to choose a comprehensive Medicare program would achieve universal coverage eventually.
Tulsi Gabbard: Yes
As with Tom Steyer below, I don’t think Gabbard is a serious contender. As a result, I’ll keep this brief.
In theory, Gabbard said about the same thing as Booker. She claimed she wants a role for private insurance in the system. But she went much further than Booker and outright adopted the ‘choice’ language of, e.g., Buttigieg and Harris. Added to Gabbard’s general unreliability on…pretty much everything, I’m declaring her a flip-flopper until proven otherwise.
Kamala Harris: Yes
Harris not only flip-flopped, but she also had the nerve to release a totally different plan using the ‘Medicare for All’ label. What’s in Harris’s plan? She wants the public to run a health insurance marketplace that includes a wide range of private insurance plans. Not only does this fail to build a single-payer system, in principle it could privatize much of the current Medicare system.
And so, Harris probably wins the award here for biggest scam.
Bernie Sanders: No
Sanders is the only clear and unambiguous “No”. Sanders hasn’t flip-flopped, and he’s not going to. Why? Medicare for All is the centerpiece of his Sandersista Trinity from 2016 and his comprehensive social democratic platform of 2020. It’s core to the Sanders brand.
Sure, if he’s elected president he might support a lesser plan as a backup. But Medicare for All is his core demand on health insurance, and it will remain so.
Tom Steyer: Yes
Steyer reneged on Medicare for All very early. In terms of health care positioning, he’s much closer to Biden and Klobuchar than to anyone else on this list.
Elizabeth Warren: No, with a ‘but’
Warren’s views on health care are difficult to unravel, and I tackled the issue in a longer post elsewhere.
But here’s the basic idea. In the early months of the campaign, Warren doubled and tripled down on the Jayapal-Sanders legislation. But, ultimately, she rejects the idea of a broad tax base. This is a problem because a broad tax base is required for a sustainable, universal public health insurance program. She released a funding plan with some very optimistic assumptions that skirts the broad tax base, but the funding plan probably doesn’t work as written.
So, in theory, she’s still a Medicare for All supporter. But, in fact, it conflicts with her underlying political philosophy. She’ll probably flip-flop at some point, but not yet.
Andrew Yang: Yes
Officially, Yang still claims he’s on board. But I don’t believe him. Why? Two reasons. First, Yang frequently conflates ‘Medicare for All’ with a ‘public option’ in his statements on health insurance. This at least suggests whatever he has in mind falls well short of the Jayapal-Sanders legislation. And, second, Yang is basically a single issue candidate. I think just about everything’s optional for him after his universal basic income proposal, which is the entire reason he’s running for president.
