Politicians are really good at fooling voters. Voters have jobs and kids and lives to lead. They are too busy to look very closely at things politicians say and do, and increasingly journalists are every bit as overtaxed and unable to do the job in their stead. We saw this during the Democratic debates. The moderators asked the candidates to raise their hands if they supported Medicare-For-All, and most of the candidates obliged. But several of the hand-raisers routinely deploy a rhetorical sleight of hand I call the “Many Paths” trick. It works like this:

Claim to support Medicare-For-All. Cosponsor or otherwise express public support for several different pieces of healthcare legislation. Ensure that one of the bills is Bernie Sanders’ Medicare-For-All bill, but also support one of the Medicare “buy-in” bills, which are permutations of Barack Obama’s 2009 public option. When asked how you would achieve Medicare-For-All, claim that you believe there are “many paths” to it.

A Medicare buy-in bill is really quite different from Sanders’ Medicare-For-All plan, because the Sanders bill creates a single payer system in which healthcare is free to the patient at the point of access. We pay tax to support Medicare, and in return Medicare covers everyone regardless of wealth or income. No individual has to worry about being left out of the rain. In stark contrast, the buy-in bills turn Medicare into just another insurance program, albeit one which is publicly run. If you have to pay to access Medicare, it’s possible that you might not have enough money to purchase access, and that means low-income citizens can still be denied access to Medicare. Some would continue to do without insurance while others would be stuck on lower quality Medicaid plans.

In short, a “buy-in” bill does not create a universal right to healthcare. It makes Medicare available only to those who can afford to buy-in. So a buy-in bill is not a “path” to Medicare-For-All, it is just a re-run of the “public option”. We discussed the other day how Pete Buttigieg plays games with this, calling his version of 2009 Obamacare “Medicare For All Who Want It”. But Elizabeth Warren and Kamala Harris play an even more insidious game. On Harris’ website, she says:

Medicare for All will eliminate premiums and out-of-pocket costs.

But Harris is also a co-sponsor of Jeff Merkely’s legislation, which would enable Americans to “buy-in” to Medicare. What’s more, she’s even co-sponsored Michael Bennett’s bill, which straightforwardly calls for a public option. When asked about the discrepancy, Harris’ press secretary said:

Medicare-for-all is the plan that she believes will solve the problem and get all Americans covered. Period…She has co-sponsored other pieces of legislation that she sees as a path to getting us there, but this is the plan she is running on.

See that word? Path. The press secretary frames these other pieces of legislation as paths to Medicare-For-All, when they blatantly do not guarantee Medicare to all.

Elizabeth Warren is even more explicit. Like Harris, she has cosponsored other legislation, including a bill to establish a state public option through Medicaid–not Medicare. At a town hall, Warren said:

When we talk about Medicare for All, there are a lot of different pathways.

She then proceeded to suggest buy-in plans, presenting them as if they were simply another way of achieving single payer:

Some folks are talking about “Let’s start lowering the age. Maybe bring it down to 60, 55, 50″…Some people say “Do it the other way. Let’s bring it up, from, uh, everybody under 30 gets covered by Medicare.” Others say “Let employers be able to buy into the Medicare plans.” Others say “Let’s let employees buy into the Medicare plans.” For me, what’s key is we get everybody at the table on this…I’ve also co-sponsored other bills including expanding Medicaid as another approach that we use.

Warren tells you what other people are saying but doesn’t take a clear stance of her own. Tellingly, despite her habit of attempting to demonstrate seriousness with detailed policy plans, there is no plan for Medicare-For-All on Warren’s campaign website. She doesn’t even discuss it in broad terms–the issue is totally absent. She has more than two dozen plans on the website and Medicare-For-All features in none of them.

If the next president is going to get Medicare-For-All passed, they are going to need support from congress, and that means they are going to need to put a lot of public pressure on recalcitrant senators. To put together that kind of pressure, they need to prioritise the issue and they need to have a clear, compelling, inspiring plan for implementing Medicare-For-All. Candidates who don’t put the issue on their websites or argue that buy-in bills are legitimate “paths” are not going to push hard enough for sufficiently robust reforms. Their support for Medicare-For-All is in name only. They will willingly support Joe Biden’s plan to implement the public option if that’s the way the winds are blowing. They won’t lead the party on healthcare–they will be led by it. For these candidates, one “path” is as good as another because the issue doesn’t matter to them. They don’t care.

Of course, they’ll try to convince you otherwise. Kamala Harris will tell you her sob story about her mother’s cancer. You know who else uses personal tragedies to cover up for banal healthcare policy? Joe Biden–who used the death of his wife and daughter to meekly push the public option:

When my wife and daughter were killed in an automobile accident, my two boys were very badly injured, I couldn’t imagine what it would have been like had we not had adequate health care available…We build on Obamacare and make sure everyone has an option.”

But at least Joe Biden takes a clear position in favour of remaining within the constraints of Obamacare. Harris and Warren play games. Harris may sound sympathetic when she speaks about her mother, but her communications director has a more flippant attitude behind the scenes, comparing different healthcare plans to varieties of Mexican-American cuisine:

Me: I want a burrito. I’d accept tacos in the meantime, but I want a burrito. CNN: Chris doesn’t want a burrito! — Chris Harris (@chris_p_harris) January 30, 2019

“Wanting” Medicare-For-All isn’t good enough. It needs to be demanded and prioritised. Because if we settle for the public option, that means that millions of Americans continue paying exorbitant premiums with no end in sight. The strength and power of a Medicare-For-All, single payer system is that it gives Medicare monopoly power over the patient pool, enabling it to dictate more affordable terms to providers. If everyone is on Medicare, providers cannot hope to earn a living without providing healthcare to Medicare’s patients on Medicare’s terms. As soon as we move away from this “single” payer and embrace multiple payers, the possibility of ever-escalating costs is reintroduced. Joe Biden’s public option isn’t a “taco”–it leaves millions of Americans without access to affordable healthcare, and it leaves the rest of us on a highway to premium hell.

There is no excuse for this. Sob stories and “many paths” speeches should not enable presidential candidates to get away with condemning innocent people to death and financial torment. Journalists must learn to recognise the “Many Paths” trick and hold those who engage in it to account.