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Elizabeth Warren’s health care pipe dream

When you’re in a hole, Elizabeth Warren, stop digging.

Barack Obama signs the Affordable Care Act.Getty Images

Elizabeth Warren has just violated the first rule of holes.

When you are in one, stop digging.

That’s what a conventional politician might do, but not Senator Warren. Oh no. She’d rather try to burrow right through the center of the Earth if there’s a chance of emerging successfully on the other side.

Consider what she’s doing by embracing a hugely expensive single-payer health care scheme that would eliminate private insurance.

For starters, she has disavowed the most significant legislative achievement of Barack Obama, the Affordable Care Act — and at a time when voters have finally realized the value of the ACA.


She has also told Americans, in the sort of high-handed fashion voters loathe in political candidates, that she will force them into a government-run health care system, no matter their personal preferences.

And now, to address cost concerns, she has offered up a financing plan that, frankly, is as politically problematic as it is fiscally dubious. Her projected 10-year price of $20.5 trillion flies in the face of credible disinterested estimates that peg such a system at $32 trillion to $35 trillion over the same period. Someone is far wide of the mark here — and Team Warren is the only one with a political incentive to make Panglossian assumptions about what’s possible to achieve by way of savings.

The reaction to her plan, which ranges from quiet skepticism to polite disagreement to eye-rolling to outright ridicule, should give pause to Democratic voters.

A generic Democratic presidential nominee should have a big advantage over President Trump on health care, given the Republican incumbent’s unfulfilled promises there. But if Warren or Sanders is the nominee, their single-payer advocacy will hand Trump a cudgel with which to assail all Democrats.


Warren rebuts concerns or criticism from her intra-party rivals by questioning their Democratic bona fides, accusing them of mouthing Republican talking points or running in the wrong primary.

Step back for a minute. Those rivals are proposing the addition of a Medicare-like public option to the ACA. If Democrats had been able to accomplish that back when Obamacare passed, they would have celebrated it as a huge victory. That was less than a decade ago. Now, however, Warren acts as though one is ideologically suspect if he or she supports that goal.

But their improve-the-ACA approach at least has some chance of passing. John McDonough, a professor of public health at Harvard who worked as a health care adviser to Senator Edward Kennedy from 2008 until Kennedy’s death in 2009, notes that even back then, with 60 Democratic senators, Democrats didn’t seriously consider single-payer, for a simple reason: “We all knew it didn’t have a snowball’s chance in hell.”

Nor will it this time around. Well, if not, a forgiving Warren supporter might argue, her advocacy of an unachievable policy really doesn’t matter then; it’s just a political statement. But that’s wrong. Given the makeup of the 2020 Senate map, which largely features contests in red or purple states, the Democrats’ chances of taking back the upper chamber are reduced if they run a single-payer advocate. However, without control of both branches of Congress, their prospects of making important improvement to the ACA decline precipitously.


So is there still a way for Warren to reduce her general election single-payer liability should she become the nominee? Yes. Here’s how: She could use House Speaker Nancy Pelosi, who says the prudent course for Democrats is to improve the ACA, and other, like-minded congressional Democrats, as a rhetorical hedge.

To do so, she’d have to note that though she herself supports single-payer, the ultimate Democratic health care proposal will have to be developed in consultation with Democratic congressional leadership — and thus must be something a working majority can support.

That would signal that though Warren is campaigning in magical, mystical, lefty-pleasing poetry, she realizes she’ll actually have to govern in practical, pragmatic prose.

But at this point, frankly, I’m not holding my breath.

Scot Lehigh is a Globe columnist. He can be reached at scot.lehigh@globe.com. Follow him @GlobeScotLehigh.