Two weeks after Elizabeth Warren released her much-ballyhooed and Warrenishly detailed plan for how she would pay for Medicare for All, the 2020 contender released another proposal on Friday about how, as president, she would transition the country to a system under which the government provides health insurance to everyone. Like the other plans from the "I have a plan for that" candidate, this document was long on details and full of proposals likely to have broad support on the left. But when you zoom out from those details, it amounts to an admission that Warren won't push for Medicare for All, and instead will embrace a more cautious path to expanding insurance coverage.
One important thing about this plan is that it is less about what Warren wants the U.S. healthcare system to look like and more about specifically what she would do as president, a level of detail that is often elided in Democratic debates. She says that she will reverse Donald Trump's executive actions that have weakened the Affordable Care Act and use the powers of the presidency to lower drug prices by cracking down on the pharmaceutical industry. She also wants the government to manufacture generic medications, and severely limit the lobbying power of Big Pharma.
But the big question facing 2020 Democratic candidates isn't about those kinds of policies, but how hard they would push for a government-provided health insurance system, a progressive goal since the days of FDR. Warren has said she favors Medicare for All, a position that has become controversial as debate moderators and her opponents have pressed her to admit such a massive expansion of government spending would require a tax increase. In this plan, she tweaks her stance somewhat: The bill she'll focus on early in her administration would be a "Medicare for All Option."
That last word matters a lot. Medicare for All is sometimes a somewhat vague phrase, but generally it means putting everyone on a single government-run health insurance system, abolishing private insurance. Warren's Medicare for All Option wouldn't be that disruptive. Instead of forcing everyone to buy insurance from the government, Warren would expand Medicare benefits and extend coverage to everyone younger than 18 and those making up to 200 percent of the poverty level. People who earn more than that and who are uninsured would pay premiums capped at 5 percent of their incomes.
By providing government insurance to those who want it, rather than requiring everyone to have it, this proposal seems akin to the "public option" systems favored by candidates like Joe Biden and Pete Buttigieg, though as the New York Times noted, Warren's slate of benefits is more generous than theirs. On Friday, the Buttigieg campaign attacked Warren's plan as an effort to "paper over" Warren's plan to "force 150 million people off their private insurance."
Warren says this isn't the end goal of her healthcare policy. "No later than my third year in office," she writes, she will push for legislation moving the country into true Medicare for All, wiping out private insurance for good. Many progressives have praised this plan, including Pramila Jayapal, the Democrat who is the chief sponsor of the House's Medicare for All bill. But the assurance that Warren will eventually get to Medicare for All wasn't enough for her critics on the left, who saw this as a capitulation. If you aren't willing to fight for full Medicare for All from day one of your presidency, they argue, you have no chance of getting it.
If Warren's plan is a dodge, it's also an extremely logical piece of political strategy. She claims that unlike Medicare for All, she could pass her bill through a Senate process known as "reconciliation," meaning it would require 50 votes, not 60. Furthermore, Warren supporters could argue, it's extremely unlikely that centrist Democrats like West Virginia's Joe Manchin and Arizona's Kyrsten Sinema would vote for Medicare for All—meaning you might not even have 50 votes for M4A—but they might vote for a slightly less radical option.
But where this pragmatism falls apart is the idea that Warren would get to Medicare for All by year three of her term. As many people have pointed out, most presidents lose seats in Congress during midterm elections and struggle to pass big pieces of legislation late in their terms as a result. A candidate saying she'll fight for Medicare for All in 2023 rather than 2021 sounds like your parents promising to get you a puppy two birthdays from now—in other words, just putting off a tough decision.
Not that there's anything wrong with that. Warren's position on healthcare is still far more ambitious than anything contemplated by the Obama administration, and she's previously said that her highest priority will be fighting political corruption (in other words, not healthcare). A President Bernie Sanders might launch a contentious, uphill battle to try to ram through Medicare for All, but a President Warren likely will not. If that wasn't obvious before this latest plan, it's clear now.
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This article originally appeared on VICE US.