WASHINGTON — Senator Elizabeth Warren now says Democrats should endorse a government-run, single-payer health insurance system for the upcoming 2018 midterm elections and beyond, after suggesting four years ago the proposal was “politically unacceptable.”
How did Warren’s position evolve? How radical of a departure is this statement for the senator, who is known to pick her political battles wisely? And what does this say for the Democratic Party? Here’s what you need to know.
What did Warren say?
In an interview with the Wall Street Journal, published Tuesday, Warren made clear she felt the President Obama’s Affordable Care Act was only an initial step to lowering health care costs.
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“President Obama tried to move us forward with health care coverage by using a conservative model that came from one of the conservative think tanks that had been advanced by a Republican governor in Massachusetts,” Warren told the Journal, referring to former Governor Mitt Romney’s universal healthcare plan. “Now it’s time for the next step. And the next step is single-payer.”
This was stronger in tone than what she said at a town hall in Framingham in March.
In a video from a recent town hall that’s featured on her campaign website, Warren responds to a constituent’s question about single-payer with more vague endorsement, saying “it’s time to put it all on the table, and talk about the options that will deliver the best possible health care options for the lowest possible price for all Americans.”
“If we’re talking about tearing down the health care system and starting over, then every option should be on the table,” Warren told reporters in a short press conference after the town hall.
In a single-payer health insurance system, the government covers core health care costs for everyone — regardless of income or health status. It severely reduces the reliance on private insurers and has been coined by some as “Medicare-for-all.” Republicans have denounced the idea as costly and inefficient, comparing it negatively to such systems in Canada, Great Britain, and Finland.
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What is the significance?
Throughout her political career, Warren has supported the themes of single-payer insurance, but has been slow to endorse the policy outright — until now.
In her 2012 race for Senate, Warren’s ill-fated primary challenger, Marisa DeFranco, consistently chided Warren for not explicitly endorsing single-payer insurance, which Warren refused to do. DeFranco made a point to mention the issue in her media appearances, and branded herself as the “only candidate in this race who supports single-payer.” Warren did not challenge the assertion.
When asked by a local television news host if she supported single-payer in June 2012, Warren said “no,” citing the political toxcity.
“I think right now what we have to do — I’m serious about this — I think you’ve got to stay with what’s possible. And I think what we’re doing – and look at the dust-up around this – we really need to consolidate our gains around what we’ve got on the table,” Warren told the host.
But that was something of a retreat from an earlier position. In 2008, then-professor Elizabeth Warren co-wrote a paper which said single-payer was the most obvious solution to “maintaining the financial stability of families confronting illness or injury.”
However, even at that time, Warren said it could be “politically unacceptable.”
“We recognize that there are cost-containment issues and the ever-present spectre of rationing medical care,” Warren wrote.
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As of Tuesday, the caveats and qualifiers appeared to have vanished. Warren is fully behind a single-payer health care system. Full-stop.
What does this mean for Democrats?
The change in Warren, one of the most recognizable currently active Democrats in the country, reflects the shifting mood of the party overall. Though Hillary Clinton fended off her presidential primary challenger Bernie Sanders — who did support single-payer— the progressive, far-left wing of the party is making inroads. For Warren, who is running for reelection to the Senate in 2018 and is a potential candidate for president in 2020, it shows the degree to which she sees the Democratic Party moving left on the issue.
Polling shows that a majority of citizens support “expanding Medicare to provide health insurance to every American.” Similarly, a recent poll from Morning Consult/Politico showed a pluralitty of voters, 44 percent of all voters and 54 percent of Democrats — support “a single-payer health care system, where all Americans would get their health insurance from one government plan.” Plus, polls show the most favorably viewed politician in America right now is Sanders.
Combined, these factors free someone like Warren to stake out a bolder stance.
Ten years ago, single-payer health care was a fringe position. It is now mainstream.
Astead W. Herndon can be reached at astead.herndon@globe.com. Follow him on Twitter @AsteadWH.