Moderate Democrats, both at the presidential level and below, are facing a quandary. All the activist energy and ideas are on the left, with policies like Medicare-for-all, a Green New Deal, a child allowance, and so on. In the main, most moderates or former moderates — like Cory Booker, Kirsten Gillibrand, Joe Biden, and so on — have expressed sympathy with lefty goals, but argued that less aggressive policy goals could be just as good. As Jon Lovett argued on a recent Pod Save America episode, "It doesn't make you less liberal" to favor preserving private health insurance, so long as it leads to a similarly good outcome.

The problem with this reasoning can be summed up in a single word: credibility. It could be the case that moderates simply think less aggressive programs are better politics and policy. Or it could be they are lying.

Here's an example of the danger I'm talking about. Ryan Grim at The Intercept reported Tuesday that immediately after the 2018 election, Nancy Pelosi's top health-care policy guy, Wendell Primus, gave a presentation to Blue Cross Blue Shield executives where he "assured them that party leadership had strong reservations about single-payer health care and was more focused on lowering drug prices[.]" Democrats are in favor of universal coverage, but see strengthening ObamaCare as the best way to do it, he reportedly told them. He reportedly "said that Democrats would be allies to the insurance industry in the fight against single-payer health care."

Grim obtained his PowerPoint presentation, in which Primus presents bullet points arguing that Medicare-for-all would cost too much, it would "create winners and losers," and probably most importantly, "stakeholders are against." Can't be having that!

As a policy matter, Primus is being rather deceptive about universal coverage. Because the Supreme Court struck down the mandatory Medicaid expansion, there is currently no way to extend coverage to the population that would be covered in states that declined it without ditching the basic ObamaCare framework. (Also, the exchanges are garbage.) At bottom, this is about sacrificing quality policy to protect private insurance companies.

At any rate, Pelosi herself is not exactly a full-blown moderate — she's maybe halfway between Bernie Sanders and Chuck Schumer. But this is a great demonstration of the uphill battle moderates are going to face trying to capitalize on the activist energy around bold policy. Pelosi told Vice that she supports Medicare-for-all in the abstract, but doesn't think the American public is quite ready for it yet. It turns out one major reason for this is that her policy staff will conspire with health insurance executives behind closed doors to keep it from happening.

Nearly all the big moderate or quasi-moderate names have problems like this. Biden, for instance, has a career that is one long smoking ruin of mass incarceration, segregation, student debt, and predatory credit cards.

Booker, meanwhile, is notoriously tight with Big Pharma and Wall Street — so much so in the latter case that he actually criticized President Obama on Meet the Press during the heights of the 2012 campaign for attacking Mitt Romney's record of job destruction at Bain Capital. Booker, who has been heavily bankrolled by Big Finance firms for his entire political career, whined that Obama's attacks were "nauseating" and he should "stop attacking private equity." Kirsten Gillibrand has a history of defending gun rights, anti-immigrant xenophobia, working for tobacco companies, and catering to Wall Street.

To be fair, most moderates attempting to play to the left have tried to make at least partial amends. Booker walked back his Bain Capital comments immediately and has since downplayed his oligarch connections in favor of criminal justice reform. Gillibrand has apologized (convincingly in my view) for her prior anti-immigrant stance and assembled a very left-wing voting record under Trump. Even Biden is talking about raising wages and cheaper college.

The trouble is that the slightest slip-up will lead people to conclude that this is just a Primus-style bait and switch. Indeed, Booker continues to vote the Big Pharma line, Gillibrand is reportedly exploring raising money on Wall Street, and Biden was most recently seen trying to solicit help from Larry Fink, CEO of the gigantic asset manager BlackRock. If they don't want the left to write them off, moderates will have to make much louder and more credible demonstrations that they have really changed their tune.