Douthat: Elizabeth Warren's health care albatross

The cost

Between the collapse of George W. Bush’s presidency and the rise of Donald Trump, the Republican Party was a more ideological institution than the Democratic Party. Both parties had litmus tests and orthodoxies, but the GOP had more of a “movement” spirit, reflecting the conservatism that had captured it, and ideological enforcers had more influence over its policy debates, more power to decree who counted as a “true conservative” and who was a “Republican in Name Only.”

In this period Republican primary debates became more implausible and fairy tale-ish than their Democratic counterparts, with long-shot candidates competing to outdo one another in ideological zeal, and center-right politicians like John McCain and Mitt Romney trying awkwardly to adopt the language of activists to prove their bona fides.

Now something similar has happened to the Democrats. The party’s leftward march began in Barack Obama’s second term, and Hillary Clinton lost in 2016 in part because she abjured her husband’s popular legacy of centrism, enabling Donald Trump to appear to many swing voters as the more moderate candidate in the race. Mirroring how tea partyers reacted to McCain’s 2008 defeat, the Clinton debacle persuaded many liberals that a still-more-ideological party was needed, and the result has been a 2020 primary campaign as shaped by activist concerns as the GOP primary in 2012.

The perils of becoming an ideological party are often framed in terms of culture-war issues, with Beto O’Rourke’s promises to seize guns and tax churches (sadly doomed to unfulfillment, with the expiration of his campaign) the liberal equivalent of Michele Bachmann’s crusading zeal. But ultimately ideological enforcement hurt McCain and Romney much more on pocketbook issues, health care and taxes especially, where under conservative pressure, they ended up staking out positions that became anchors on their general-election campaigns.

That is the danger facing the Democrats, and particularly their quasi-front-runner Elizabeth Warren, with the issue of “Medicare for All.” Single-payer health care is, in certain ways, the liberal-activist equivalent of the conservative dream of a flat tax. It’s an idea of some merit if you’re designing a system from scratch, and it polls OK if you don’t tell people about the trade-offs. But it tends to run into trouble quickly on the state level — with Vermont’s stillborn single-payer experience mirroring the flat-tax experiments of states like Kansas. And it has enough political vulnerabilities, in terms of costs and disruption both, that no sane Democrat should want it as the centerpiece of their national campaign.

Warren, who is definitely sane, clearly doesn’t want to make it her centerpiece; you can tell that she’d like to run on her promise to tax the wealthy to pay for free child care and college, with a dose of anti-corruption and trustbusting on the side. These ideas have their own difficulties, but they’re popular and responsive to the voters, and a good foil for Trump’s record of corporate tax cuts and not much else.

But being a progressive candidate in a leftward-marching party required her to sign on to Medicare for All, and being the “I’ve got a plan for that” candidate in a party that still fetishizes wonkery required her to roll out a big, multitrillion-dollar proposal Friday. (Kamala Harris, the Tim Pawlenty of 2020, attempted Medicare for All evasiveness and fell off the map.) So now if Warren wins the nomination, she’s going to drag a multitrillion-dollar renovation of the U.S. health care system into the fall campaign — even though everyone understands that the renovation won’t happen, even though Warren herself would rather talk about other policies that poll better. An ideological party is a harsh mistress.

Of course, Team Warren and its many adjuncts in the press will argue that one, this is the primary campaign and there’s time to pivot toward the center, and two, that Warren’s plan is superclever in its avoidance of overt middle-class taxation.

The second point seems weak to me; the potent fear of health insurance disruption will suffice to make Medicare for All a liability, even if Warren isn’t waving a specific list of middle-class tax hikes, and her slippery health care math could reflect badly on all her other, more popular proposals.

The former claim, meanwhile, is one that Teams Romney and McCain often made in their campaigns; recall the Romney adviser who explained how they would simply shake the Etch A Sketch when the general election rolled around. But it’s rarely that easy because your opponent gets a chance to set the terms of the debate — which is why Romney’s primary season plan was savaged as a middle-class tax hike, despite all his attempted pivots, deep into the fall of 2012.

What makes Warren different from Romney, of course, is that she has many more media adjuncts willing to give her math the benefit of the doubt, and also she’s running against Trump. Highly ideological parties and candidates can win elections in the right circumstances, and a race against an unpopular, unfit and impeachable incumbent might be one of them.

But it would still be a folly, a case study in ideology’s exacting costs, for the Democrats to take the chance.

— Ross Douthat writes for The New York Times.

Today's Bible verse

“Surely your goodness and love will follow me all the days of my life, and I will dwell in the house of the Lord forever.”

— Psalm 23:6

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