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Ideas | David Scharfenberg

Will ‘Medicare for All’ destroy Elizabeth Warren’s campaign?

Democratic presidential candidate Elizabeth Warren showed her support for striking Chicago school teachers on Tuesday. The Democratic presidential race seems to be boiling down to a single question.
Democratic presidential candidate Elizabeth Warren showed her support for striking Chicago school teachers on Tuesday. The Democratic presidential race seems to be boiling down to a single question.Scott Olson/Getty Images/Getty Images

MORE AND MORE, the Democratic presidential contest seems to be boiling down to a single question:

Is Elizabeth Warren electable?

The Massachusetts senator’s broadsides against the superwealthy and promises of “big, structural change” have set liberal hearts aflutter.

But even as Warren climbs in the polls, Democratic voters are fretting about whether she can beat President Trump next year.

The doubts have only intensified in recent weeks amid mounting scrutiny of her “Medicare for All” proposal, which would wipe out private health insurance and move patients into a government-run system.

A candidate who has built her campaign on wonky point-by-point prescriptions for everything that ails America — “I have a plan for that” — has been vague about how she would pay for her most sweeping plan of all.


And a promise to release a detailed blueprint in the coming weeks — one that will probably have to include middle-class tax hikes ready-made for Republican attack ads — has done little to calm the party’s nerves.

But with the first caucuses just 14 weeks away, Democrats are running out of time to make what feels like one of the most consequential decisions in modern American politics. And everyone’s got a theory about the electability question — liberal activists, pollsters, pundits.

Some hold up. Some do not. Others are maddeningly difficult to pin down.

.  .  .

THERE IS A tendency, in certain progressive circles, to dismiss concerns about electability altogether.

To guffaw at the pundits’ obsession with “swing voters.”

In our polarized politics, the argument goes, the key to victory is mobilizing your base, not pandering to some mythical — or vanishingly small — middle.

But the political science on this point is pretty definitive: Swing voters exist. And they can make a real difference in elections.


Surveys show that fully 11 percent of Trump’s 2016 voters — some 6.7 million people — voted for Barack Obama just four years earlier.

Trump won those voters, in part, through emotive appeals to the struggles and resentments of what he called “the forgotten men and women of our country.”

But he also won them over by taking popular stands on the issues, often in defiance of his own party. He was openly disdainful, for instance, of GOP plans to slash Social Security.

Warren is more of an ideologue, much more in line with her party’s traditional positions than Trump is with his. But it’s easy to hear echoes of the president’s populism in her campaign.

Her push for a wealth tax on the uber-rich taps into deep anger about our lopsided economy. And polling has consistently shown overwhelming support for the idea, with two-thirds to three-quarters of Americans backing it.

Her signature calls for expanding Social Security and cracking down on corruption in Washington are enormously popular, too.

And Warren has used her own story of growing up on the “ragged edge of the middle class” in Oklahoma to personalize her platform.

None of this guarantees that she’ll win over enough swing voters. But there’s every reason to believe that much of what she says — much of what may seem radical about her platform — will appeal to them.


The more pressing question is whether a handful of controversial positions — including support for decriminalizing border crossings and for Medicare for All — will prove campaign killers.

.  .  .

Warren spoke Thursday during an appearance at Dartmouth College in Hanover, N.H.
Warren spoke Thursday during an appearance at Dartmouth College in Hanover, N.H.Craig F. Walker/Globe Staff/Globe Staff

AT THE MOMENT, Medicare for All isn’t a significant drag on Warren’s campaign — or on that of Bernie Sanders, a Democratic rival who has long championed the idea.

There’s solid support for the plan among Democratic primary voters. The broader public is reasonably warm to the idea, too.

A Kaiser Family Foundation poll this month found that 51 percent of Americans favor Medicare for All and 47 percent are opposed.

But there is underlying cause for concern. Support for the plan has narrowed in recent months. And Kaiser surveys show that it craters when voters are exposed to two of the most common critiques of Medicare for All. Told that the policy will require a tax hike, 60 percent of Americans come out in opposition and just 37 percent remain supportive. Likewise, 58 percent oppose Medicare for All when they learn that it will eliminate private insurance, while 37 percent still back the idea.

Adam Green, cofounder of the Progressive Change Campaign Committee, which is supporting Warren, says that kind of polling drives him nuts.

A legitimate survey, he argues, needs to include counterarguments, too — that you’d get to keep your doctor under Medicare for All; that you’d be able hold on to your insurance even if you’re fired or switch jobs; and that, while your taxes might go up, you’d no longer have to pay premiums or copays, and you’d wind up with more money in your pocket.


He points to a survey his group commissioned — take it with a grain of salt — suggesting that support for Medicare for All rebounds when voters hear those counters.

“Democrats can’t live in fear of Republican attacks that will come no matter what the Democratic nominee’s positions are,” he says.

Green is right to suggest that the Trump campaign will criticize even the more incremental health care proposal offered up by Democratic candidates like Joe Biden and Pete Buttigieg — a “Medicare for all who want it” plan that would allow people to stick with their private insurance if they chose or buy into the Medicare system voluntarily.

Kaiser polling suggests that a likely line of attack on this so-called public option — that it will lead to too much government involvement in health care — could be quite effective (leaving just 40 percent in favor of the idea and 57 percent opposed).

In other words, if Medicare for All comes with political risk, well, so does the leading Democratic alternative.

Still, there is something artificial about the carefully worded back and forth of polling questions. Real-life campaigns often play out quite differently.

And there is reason to believe a public option would leave Democrats on firmer ground. Surveys show that it starts out substantially more popular than Medicare for All, leaving a greater margin for error.


And as John McDonough, a professor of public health at Harvard who played a key role in the development of the Obamacare legislation, notes, Medicare for All — or “single-payer” health care — has not fared well in the hurly-burly of political combat.

Some version of the idea appeared on the ballot in three states over the course of the last several decades — California in 1994, Oregon in 2002, and Colorado in 2016. In each case, it was thumped, with about three-quarters of voters in opposition.

McDonough says concerns about how to pay for the program — the very concerns that are hanging over the Warren campaign right now — played a major role in each of the defeats. “When you get into that discussion,” he says, “you get into a ditch — and you never climb out of it.”

.  .  .

Warren spoke to journalists last week after a town hall in Indianola, Iowa.
Warren spoke to journalists last week after a town hall in Indianola, Iowa. Melina Mara/Washington Post

STILL, A PRESIDENTIAL race differs from a ballot-measure campaign in some important respects.

It’s about a range of issues, not just one. And it’s about the personalities and visions of the candidates.

Anna Greenberg, a Democratic pollster who worked on former Colorado governor John Hickenlooper’s aborted presidential campaign, says a Medicare for All proposal will undoubtedly provide fodder for Republican attack ads.

But the Trump campaign won’t engage in a point-by-point critique of the policy, she says.

It will roll Medicare for All — or Medicare for all who want it — and the Democrats’ sweeping Green New Deal plan for tackling climate change into a larger argument about the role of government. “It’s going to be ‘government takeover of the economy’ and ‘a trillion dollars of taxes,’ ” Greenberg says.

It’s not just the Democratic nominee for president who will face that attack, she says. Every Democratic candidate in a close-fought House or Senate race will face some version of the same.

Greenberg is actually quite bullish about Democratic prospects in an election fought on the grounds of health care — polling shows the party has more credibility on the issue than the GOP.

And if impeachment remains the dominant concern in American life — or some other unpredictable Trump development lands front and center — it’s possible that any flaws in the Democratic presidential nominee’s health care plan will become a comparatively small factor in the race anyhow.

But in a tight contest, it’s hard not to worry that a call for a major overhaul of such a large part of the economy — and such a large part of voters’ lives — could tip the election toward a president Democratic voters have come to revile.

Earlier this year, Warren sounded more cautious about health care reform. Her full-throated embrace of Medicare for All in recent months felt, at least in part, like an attempt to win over the left wing of the party.

She’s won a significant share of that wing. In several polls, she leads the entire Democratic field.

Here’s betting that many of the senator’s supporters would stick with her if she returned to a bit of her earlier caution.

David Scharfenberg can be reached at david.scharfenberg@globe.com. Follow him on Twitter @dscharfGlobe