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How Warren's plan changes the terms of the 'Medicare for All' debate

Analysis: The 2020 Democrat's front-runner status made her a target, and her careful positioning could insulate her from some, but not all, attacks on the issue.
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WASHINGTON —The war over "Medicare for All" is only getting started, but by putting out a plan Friday that she says will pay for it, Democratic presidential candidate Elizabeth Warren may be better positioned to head off some of the more immediate political threats it poses to her campaign.

Whether it's an effective blueprint for governing is another story, and policy experts on both the left and right are debating that side of it intensely as they digest the details. But her opponents will have to find at least one new line of political attack come November's debate, unable to say she hasn't come forward with the details.

Warren's lack of a policy on a crucial issue had threatened to undermine her brand as the candidate with a plan for everything, a weakness that South Bend, Indiana, Mayor Pete Buttigieg — who increasingly looks like a threat to her in Iowa — exploited in the last match-up.

Her newly minted front-runner status made her a target on the issue, and she danced around repeated questions about whether Medicare for All would increase taxes on the middle class, despite having endorsed the bill written by Sen. Bernie Sanders, I-Vt., who has acknowledged there would be a tax hike while arguing the costs would be offset by overall savings.

Now, having released the revenue and cost estimates her opponents criticized her for omitting, it’s a much more complicated fight, which will center on competing estimates and expert analysis and nuanced arguments about what counts as a tax on which people. That could make it harder to litigate on a crowded debate stage.

“Very few people really understand what's going on in these proposals, certainly not regular people, so the whole thing turns on what the media is willing to say to the masses on all of this,” Matt Bruenig, founder of the socialist People’s Policy Project, told NBC News.

Another threat her proposal attempts to neutralize is the way her Medicare for All bill tests her political coalition, which is effectively an alliance between the middle and upper-middle class against the ultra-rich. Her signature wealth tax starts at fortunes over $50 million and uses its revenue to fund broad benefits in education and child care. It’s not so much the 99 percent versus the 1 percent, as it is the 0.1 percent or 0.01 percent.

Medicare for All’s benefits, by contrast, are more nuanced when it comes to class. While it’s possible most Americans would see their overall costs go down, individual results could vary and it’s not clear at which point in the income ladder people go from relative winners to losers without knowing its price tag, structure, and financing.

Warren’s plan doesn’t fully eliminate these concerns, but through great effort and some optimistic assumptions, she arguably did structure it to avoid a widespread direct tax increase on the middle class.

But there are also serious arguments about whether Warren’s plan is politically viable, technically workable, or meets its stated goals. (And that's beyond the political problem she faces in eliminating private insurance, which is opposed by many centrist Democrats.)

Opponents are already challenging Warren’s claim that there will be “not one penny” in middle-class tax increases, as well as her broader math. Former Vice President Joe Biden's campaign points out that Warren’s proposal creates an $8.8 trillion payroll tax on employers that experts say is passed on to workers — and they have some backup from tax experts.

Warren’s campaign, with backing of her own from some health policy experts, argues it’s an unfair comparison, because it replaces an estimated $9 trillion employers were already expected to pay in health care.

Critics also argue her plan relies on very generous assumptions to make the numbers add up: Raising more than $2 trillion in revenue from better tax enforcement alone, for example, or demanding deeper health care savings than some outside studies argue is possible. Like other single-payer proposals, her plan calls for significant savings from health care providers and drug companies that are likely to meet fierce opposition from industry groups. Some tax experts on the right argue the additional taxes on corporations and investors would slow the economy.

“The math is magical, the middle class will be on the hook, and some of the proposals are landmines,” Jim Kessler, executive vice president at the centrist Third Way, said in a memo.

On the pro-single payer left, Bruenig has argued the plan was less progressive than it would be if it used a simple payroll tax, which would land on the middle class but force higher earners to pay more than her tax on employers.

“The main purpose of the proposal appears to be to find a plan that you can message as ‘not increasing middle class taxes,’” he wrote in a blog post.

In the meantime, it’s possible Warren's careful positioning could come with some real political upsides.

Sean McElwee, founder of the left-wing polling firm Data for Progress, said the data suggests there’s value to denying opponents a damaging sound bite on taxes. Respondents to a survey his group conducted with YouGov Blue said they backed a Medicare for All plan that does not raise taxes on the middle class by a 57-30 margin, a much higher show of support than other surveys that acknowledged higher taxes.

If one believes House Speaker Nancy Pelosi, D-Calif., and the many Democrats who have suggested single-payer health care like Medicare for All has virtually no chance of passing anytime soon, a plan that gets Warren through an election cycle may be more valuable than one that could credibly go into effect tomorrow.

“To some extent, I take the ‘campaign in poetry/govern in prose’ philosophy,” McElwee said. “Questions of [budget] scores and stuff will become a problem when we have to move this through the House and Senate, but that will occur after the 2020 election.”