DES MOINES — In warm-up remarks introducing Senator Elizabeth Warren at campaign rallies, young volunteers often say they are supporting her because of her plan to transform the health care system through a single-payer “Medicare for all” program. It happened in Des Moines on Saturday and Oklahoma City last week, and in western Iowa cities like Clarinda and Council Bluffs on Sunday.
But Ms. Warren herself is barely speaking of the proposal. After months of attacks from other candidates, and questions and some blowback from both liberals and moderates, the most ambitious and expensive of Ms. Warren’s many plans — and the one most likely to transform the lives of voters — is just a passing mention in her standard stump speech, rarely explored in depth unless a questioner brings it up.
“I expected her to talk more about the health care for all stuff, definitely,” said Max Goldman, 53, who attended Ms. Warren’s rally in Clarinda. Referring to her campaign, he added, “I think they know it’s controversial.”
Austin Thornton, a 32-year-old Iowan who works in film production, said he noticed Ms. Warren largely outsourced Medicare for all to another speaker. Mr. Thornton said it was a notable difference between her events and those he attended for Senator Bernie Sanders, who is vying with Ms. Warren for liberal voters in Iowa and elsewhere.
“Bernie, he’s strong on Medicare for all, and she didn’t really bring it up,” Mr. Thornton said. “She was a little more scattered on it than I expected.”
With five weeks left before the Iowa caucuses, Ms. Warren is tailoring her closing message in the state to focus on rooting out Washington corruption, a potentially resonant theme with a Senate impeachment trial of President Trump expected in January. In a speech in Boston on Tuesday, she reiterated her case against corruption and asked voters to “imagine” a post-Trump era; she did not delve into many policy specifics, and mentioned Medicare for all only once.
Her campaign aides insist that fighting corruption has always been the message, and Ms. Warren has long argued that, more than any individual proposal, her suite of plans is rooted in an overarching vision of changing how Washington works, including reforms in campaign finance and lobbying.
Yet this approach, which includes shorter opening remarks and more time for audience questions, has also allowed Ms. Warren to keep her own health care plan at arm’s length at a time when she has been facing significant scrutiny. It is a clear indication that, in a tight multicandidate race in Iowa, Ms. Warren has not become fully comfortable with staking her candidacy on her plan for health care, even as many Democrats cite the issue as their top priority.
Speaking to reporters in Council Bluffs on Sunday, Ms. Warren said that if Medicare for all has received little attention at her Iowa events, it’s because “I take whatever questions come my way” and the voters have had other concerns.
And she rejected the criticism, mostly lobbied by ardent progressives, that her plan waffles on an immediate push for enacting Medicare for all and ending private health insurance, as Mr. Sanders has long proposed.
In November, after Ms. Warren faced blowback for her proposal for $20.5 trillion in new spending over 10 years to enact Medicare for all, she surprised many by proposing an expansion of public health insurance as a first step — similar to the positions of rivals like Joseph R. Biden Jr. and Pete Buttigieg — and then achieving passage of Medicare for all by the end of her third year in office.
Ms. Warren’s campaign and its surrogates say that the type of insurance offered under their plan is more comprehensive than Mr. Biden’s and Mr. Buttigieg’s proposals, and that the Warren camp has provided more details on how to implement and finance a single-payer system than Mr. Sanders.
“I’m still with Bernie and we’re still there on Medicare for all,” Ms. Warren said in Council Bluffs. “I still think it’s the right place.”
But there are signs that her campaign is proactively seeking to calm fears about her health care proposal. Denise O’Brien, a rural community activist and prominent supporter of Ms. Warren’s from Atlantic, Iowa, said she and other supporters have been coordinating with the campaign to hold Medicare for all “listening sessions” in her town.
Ms. O’Brien said that she will soon hold her third event, and that community members have had several questions, particularly since Ms. Warren was pressed during the Democratic debate in October. The typical running order of the sessions, she said, is that a doctor who supports Medicare for all explains the health care insurance system and its pitfalls, while a campaign staff member lays out Ms. Warren’s position.
They also take questions, in an attempt to quell concerns.
“People don’t like to hear ‘free,’” Ms. O’Brien said. “And we kept getting questions, so that’s why we’re having more meetings.”
It is unclear how much the Medicare for all issue has hurt Ms. Warren, if at all. Her poll numbers in Iowa leveled off in November and December, following attacks on her health care position and other issues in the October Democratic debate and questions about her plan’s details in the first half of November. But polling has been sparse in Iowa in recent weeks, and Ms. Warren has one of the largest teams of political organizers in Iowa.
In national polls released in the past two months, Ms. Warren has fallen behind Mr. Sanders, a fellow liberal on many issues but also a vocal champion of single-payer health insurance who has focused his candidacy on health care. In recent days, Ms. Warren’s campaign has also announced a dip in fund-raising ahead of the year’s end, and is widely expected to raise less money than Mr. Sanders.
For many Warren admirers who attended her Iowa rallies last weekend, no polls are needed for confirmation: They believe health care has been her Achilles’ heel. Several said in interviews that they noticed Medicare for all was sparsely mentioned by Ms. Warren, but they spun it into a positive; arguing that her anti-corruption message appealed to a wider audience.
Even Mr. Thornton, who said Ms. Warren was “scattered” on health care, said he still plans to vote for her over Mr. Sanders, whom he backed in 2016.
“She elaborates and widens the scope,” he said. “I get that corruption is at the top and it bleeds into those other issues. It touches every issue.”
Mindi Callison, a 30-year-old who saw Ms. Warren in Des Moines, said by taking more questions, Ms. Warren talks about issues many other candidates ignore, like primary education or child care.
“We know what she’s about” on health care, Ms. Callison said. “You see her commercials on that, you see her emails — we know.”
The arguments over health care were supercharged by more moderate Democrats, like Mr. Biden and Mr. Buttigieg, who once called Ms. Warren “extremely evasive” on the issue. For these candidates and their supporters, whom Ms. Warren was attracting this summer, health care was partly about the policy specifics but also a stand-in for larger concerns — for example, Democrats feeling risk-averse ahead of a general election against Mr. Trump.
But while moderates say liberal policies make it harder to beat Mr. Trump, Ms. Warren’s supporters argue her clear convictions and authenticity will mobilize voters.
Stephen Hueholt, 29, said he came into Ms. Warren’s Des Moines rally undecided, but left excited to caucus for her in early February.
“When she talked about fighting for what she believes in, the authenticity, that’s what’s important,” Mr. Hueholt said. “It’s not as much Medicare for all, though I know that’s an important issue — it’s that we know that she stands and fights.”
Ms. Warren has staked so much of her candidacy and political brand on policy details that some of her supporters argue that, on health care, she has been judged on a higher standard. She has provided more specifics about her health care vision than many of the Democratic rivals who criticize her — but it is also those details, particularly on Medicare for all, that have ignited controversy.
Still, because of that emphasis, a health care-size hole can sometimes seem missing from her speeches, as when she listed the top priorities of her prospective administration in her closing remarks in Des Moines.
“After we win in 2020, nobody gets to go home,” Ms. Warren told the crowd. “We all come back to push. Push on the anti-corruption bills. Push to get rid of the filibuster. Push to make changes in our immigration system. Push for a 2 cent wealth tax. To push for a Green New Deal. You push and I pull and we will make real change.”
No mention of Medicare for all.
Astead W. Herndon
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