Elizabeth Warren is writing a political suicide note for the Democrats

She's got some great ideas — but there's no way they're going to work

The simple fact is that American progress has always been incremental. Congressional reactions to Obamacare prove this more than anything (AP)

Elizabeth Warren has a plan for everything. She wants to move to single-payer health insurance and effectively shut down the private insurance market. She was assailed for not explaining how it would be paid for. The policy wonks worked overtime to come up with a price: $20 trillion. She supports free college tuition, universal childcare, breaking up the big banks, breaking up the tech giants, banning fracking, and major changes to the organization of the economy, corporate governance and the role of government in economic planning.

These are all interesting ideas. But American voters are famously afraid of change and complexity.

To be sure, Warren has identified major issues in the American economy, but her plans, taken individually, are largely untried, too expensive, and too much and too soon for the American polity. Taken together, they evoke Gerald Kaufman’s famous put-down of the 1983 Labour Party manifesto in Britain: “the longest suicide note in history.”

Healthcare has always been and remains the most important and volatile issue for American voters. Obamacare, a fairly incremental reform that provided health insurance to tens of millions, was at the heart of the “shellacking” of the Democrats in the 2010 elections, leading to a Republican-led gridlock for the ensuing six years of the Obama administration.

Now Obamacare is popular because it is familiar. The 2018 wipeout of House Republicans was a referendum on the Democrats’ embracement of Obamacare and the Republicans’ attempt to dismantle it without any concrete, coherent counter-proposal.

Enter the left wing of the Democratic party. These progressives want to dismantle Obamacare, which is working reasonably well despite the Trump administration’s attempt to eviscerate it at every turn. Elizabeth Warren and Bernie Sanders, two of the three leading candidates, want to replace Obamacare with something that may be more radical than the UK’s National Health Service, as it appears to preclude private insurance altogether.

This could be the subject of a fascinating Ivy League seminar. European single-payer systems appear to provide better health outcomes at a much lower cost. European systems have controlled costs and managed the system for decades, writing on a clean slate after the Second World War when most people had no health insurance or provision. From nothing, they received something that has become the bedrock of a social safety net.

But let’s be clear: in the United States, there is no way that a majority will trade something real for something unknown. it is a political impossibility, a third rail that may be the only possibility for enabling the re-election of the most corrupt, inept president in American history.

Americans may hate their health insurers, but they will never buy into a single-payer system all at once.

Change in the American system is incremental. The Warren and Sanders plans are not. They will never be supported by the hundreds of thousands of people employed in the insurance industry; they will never be supported by doctors or hospitals or pharmaceutical companies. And Congress, awash with healthcare industry cash, will never vote for these plans. If the Democratic party nominates a Medicare-for-All candidate, it will have potentially sacrificed an election for the sake of an abstract idea that would only be acceptable after years of dialogue.

To be sure, there are ideas that could work well, provide better health outcomes and not scare the bejeezus out of most of America. A public option could compete with private plans and if it provides better service at a lower cost, it would win in the marketplace. The government could remove the pharma-inserted provision of the Bush pharmaceutical benefit that prohibited negotiation of bulk discounts, leading to the unsurprising result that Americans pay the highest drug prices in the world for identical products. States could be incentivized to accept the expansion of Medicaid to the near-poor so they do not access healthcare at emergency rooms, which is wildly inefficient and unreliable.

But for the Democrats to fall on their sword for single-payer health insurance is a sacrifice that is as pointless as it is dangerous to the country. Elizabeth Warren famously asks: Why run for president unless you want to put forward “big ideas”? The answer is simple — to win.