Are Democrats Willing to Pay More in Taxes for Medicare for All?

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Senator Elizabeth Warren has surged to the front of the Democratic pack by promising “big, structural change” — including a “Medicare for all” program that would bring health insurance to all Americans and eliminate private coverage.

But at Tuesday’s presidential debate, she again refused to say whether taxes would go up in order to pay for such a program. That reticence suggests that Ms. Warren, who was an Oklahoma-born Republican decades before she became a liberal Massachusetts senator, worries about alienating voters fearful of higher taxes and bigger government.

By contrast, Senator Bernie Sanders of Vermont, who wrote the Medicare for All bill that Ms. Warren has said she supports, openly admitted on Tuesday that taxes would go up but that any increase would be “substantially less” than what people currently pay for premiums and out-of-pocket expenses.

Polling data show that Democrats are largely united in their willingness to pay higher taxes in exchange for a government-run health insurance system. But it is unclear if the broader electorate — which is sympathetic to Mr. Sanders’s and Ms. Warren’s calls for a wealth tax of the superrich — would accept a middle-class tax hike in exchange for such a system.

Soon after the debate, Mr. Sanders announced he would be receiving endorsements from two young high-profile progressives: Representative Ilhan Omar of Minnesota, who backed him on Tuesday, and Representative Alexandria Ocasio-Cortez of New York, who is expected to endorse him at a rally in Queens on Saturday. By proudly embracing his left-wing agenda, Mr. Sanders is staking a claim to the liberal-most parts of the Democratic base, while banking on his ability to still build a diverse coalition.

While Ms. Warren is also angling for support from the party’s left wing, she has avoided mentioning middle-class tax hikes that might alarm moderate voters whom she is trying to peel away from former Vice President Joseph R. Biden Jr., and some of whom she would need to win a general election.

“She’s positioned herself pretty effectively as someone who has a plan and has thought it out, but the burden is on her to explain the math around the plan,” Doug Sosnik, a former senior adviser to President Bill Clinton, said of Ms. Warren’s support for Medicare for all.

A recent Des Moines Register/CNN/Mediacom poll showed that roughly 7 in 10 Democratic voters in Iowa, the first state to vote next year, said they were “comfortable” with a Medicare for all system, though about two out of every five voters in that group worried that embracing this position “could cost Democrats the election.”

In national polls, Democratic voters have overwhelmingly said they would accept higher taxes to fund a government-run health system that covers all Americans.

A NBC/Wall Street Journal poll in July found that 72 percent of Democratic voters nationwide, largely liberals, said they would support a taxpayer-funded, single-payer health care system. Even moderate and conservative Democratic voters supported the idea, at 57 percent. Younger Democratic voters were particularly likely to back a single-payer system.

But support was mushier across party lines, according to the poll. Just 44 percent of all American voters supported a single-payer plan funded by taxes.

And when given a choice between Medicare for all and a public option, even Democrats remain split.

In a July study, Pew researchers found that 4 in 5 Democrats believed it was the government’s responsibility to ensure all Americans have health care. But in a follow-up question on how it should be administered, just 44 percent of all Democrats favored a Medicare for all model, while an additional 34 percent said they would like to see a public option operating alongside private insurers — the approach favored by Mr. Biden and more moderate Democrats.

Among the general population, just over a quarter of Americans said they would choose a Medicare for all-type system, according to the Pew survey.

Mr. Sanders and Ms. Warren have made two claims central to their candidacies: that only Medicare for all would be enough to make health care affordable for every American, and that the richest Americans ought to pay far more in taxes than they currently do.

A tax hike for the wealthy is broadly popular — especially among Democrats, but also with independents.

“Voters across the board actually support higher taxes on the wealthy and on corporations,” John Hudak, a senior fellow at the Brookings Institution, said in an interview. “But in terms of understanding whether people are supportive of raising their own taxes to get certain social benefits, the evidence is mixed.”

Polling data suggest that in recent years, the country has grown less resistant to federal taxation. In both 2018 and 2019, Americans responding to Gallup polls have been more likely to say that the amount of federal income tax they pay is “about right,” rather than “too high.” This marks the first time since the 1950s, when Gallup started asking the question, that public opinion has swung that way two years in a row.

Only a quarter of those polled by Gallup this year said they were “very dissatisfied” with the amount of taxes Americans pay — the lowest percentage since the question was first asked in 2001.

But most of that change has taken place among Republicans, who have historically been the most averse to federal taxation. This shift may speak to Republicans’ satisfaction with President Trump’s 2017 tax law — which broadly lowered taxes, but delivered the greatest benefits to wealthier Americans — more than an increased willingness to be taxed in exchange for public services.

But the Trump tax law has added to the view among most Americans that the federal tax system unfairly favors the rich. In a March Pew poll, 80 percent of Americans said they were bothered at least somewhat by “the feeling that some wealthy people don’t pay their fair share” in taxes.

Therefore, Mr. Hudak said, the message of a wealth tax could catch on with the general electorate. Whether this will transform into additional support for Medicare for all remains uncertain.

“Simply because something can be paid for with a tax increase on the wealthy doesn’t necessarily make it a good idea in all Americans’ eyes,” he said.

With regards to Medicare for all, he said, “those who are skeptical of it are skeptical beyond what it would cost. They’re skeptical about implementation, they’re skeptical about access, and in some cases they’re skeptical that that system will be better than the current health care system for them personally.”