Bernie Sanders’ Medicare for All Promise Is Impossible

Elizabeth Warren got pummeled for trying to face reality. Her rival is promising a fantasy of passing it in the next two years.

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Last month, Sen. Elizabeth Warren suffered for trying to find both a politically palatable way to fund Medicare for All and a multiple-step path for its eventual enactment. Warren was assailed by candidates and journalists, slipping in presidential polls after the troubles. Meanwhile, Sen. Bernie Sanders’ campaign has managed to skate by the same obstacles despite making a bigger Medicare for All claim: that he can actually pass the bill during his first two years as president.

If Sanders won the White House, delivering this promise would take a true political miracle. Sanders has his version of that, vowing a “political revolution” will defeat any opposition. Pretending Medicare for All is a real possibility in the short term raises questions of whether Sanders is being honest with his supporters or with himself about the biggest plank of his campaign.

Finding 50 senators who support Medicare for All in principle is just the first step.

To fully understand how difficult President Sanders would find passing Medicare for All requires performing what’s known in politics as a “whip count,” a systematic attempt to find the most likely senators to get enough votes.

For starters, Sanders needs Democrats to win the Senate. Most forecasts project Republicans are likely to maintain control of the Senate after the 2020 election, given how strongly the map is tilted in their favor. Even if Democrats take the Senate, Medicare for All is certain to face a Republican filibuster, so Sanders also needs at least 50 Democratic senators (plus his vice president casting the tie-breaking vote) willing to eliminate or effectively eliminate the filibuster and support Medicare for All.

Starting with just 10 votes

Right now there are only 10 senators expected to be in Congress next year who co-sponsored his Medicare for All bill and haven’t publicly backed away from it since the start of the presidential primary. Let’s assume that if Sanders wins big, though, he can convince senators such as Kamala Harris to rejoin the fold.

Getting to 28: Beat Republicans overwhelmingly in nearly every race

Next, Sanders would have to assume that in every open or Republican-held Senate seat on the ballot, the Democratic nominee selected in the primary is willing to support Medicare for All. That alone would require a near miracle. For example, in Colorado, polling shows former Gov. John Hickenlooper with a huge lead in the Democratic primary. Hickenlooper has very publicly taken a stand against Sanders’ bill. In fact, at this point all of the likely Democratic nominees in the four seats most likely to be flipped by Democrats don’t back Medicare for All.

Then you have to assume supporters of Medicare for All will win every one of the primaries, but will also win every Senate race ranked as lean Democrat, toss-up, lean Republican, and even likely Republican. That means Medicare for All candidates winning in Montana, Texas, Kentucky, Mississippi, Iowa, Georgia, and Kansas. Even a landslide like this gets Sanders half the support he needs.

Getting to 35: Primary all reluctant 2020 Democrats

Now it gets really hard. There are seven incumbent Democratic senators up for reelection in 2020 who haven’t sponsored Sanders’ bill. Supporters of Medicare for All could try to primary them to either replace them with Democratic candidates who back Medicare for All or scare them into changing positions.

First, this is difficult because primarying an incumbent senator is very hard and can endanger losing the seat to a Republican. One of the incumbent Democrats running in 2020 is Doug Jones in Alabama, who won a special election by less than one percentage point. Finding a Democrat who supports Medicare for All who can beat him in the primary and go on to win the general election there would be a very tall order. Second, many of these primaries will take place before Sanders would likely have the presidential primary wrapped up, limiting his ability to influence them.

Even if Medicare for All candidates win every Senate Democratic primary and every marginally competitive Senate race in 2020, that would still leave Sanders at least 15 votes short in the Senate.

Getting to 42: Threaten to primary Democrats in 2022

The next logical place to look for votes would be Democrats up for reelection in 2022. If Medicare for All supporters had successfully primaried several sitting senators in 2020, that might scare some of the Democrats up for reelection in 2022 to support Medicare for All. Of course, these senators might be scared into just resigning, which would leave Sanders and activists with little leverage. Even if every one of these 2022 Democratic senators could be scared into backing Medicare for All, that still nets only another seven votes.

Getting to 50: Beg and plead?!

Even under this unbelievably perfect-case scenario, Sanders would still need to win over at least eight more senators out of a pool of 17 Democratic senators who won’t face reelection until 2024. These are senators Sanders and activists will have little power over. To understand how hard it would be to simply convince them without any immediate leverage, consider that of these 17 Democrats, the eighth most liberal senator is Amy Klobuchar — who has spent her presidential run attacking the Medicare for All bill by calling it a “bad idea.” This is because six of the eight most conservative members of the Democratic caucus aren’t up for reelection until 2024.

That is all just for step one of three

Finding 50 Senators who support Medicare for All in principle is just the first step. The second would be to produce a similarly dramatic transformation in the House of Representatives, where the bill has only 119 co-sponsors, with 218 votes required. (Granted, lawmakers often vote for bills they do not co-sponsor.) Since House seats are up every two years, that would at least be marginally easier.

The third step would then be choosing a funding mechanism which nearly all of the lawmakers who support Medicare for All in principle would agree to. Neither Sanders nor House Democrats have done the work of designing and building popular support for a specific funding plan; neither the House nor Senate bill has a funding section. So far they are only building support for the benefits, which is the easiest part. Among international efforts along similar lines that have failed, it has usually been due to disagreements over funding.

All of this is not to say Medicare for All eventually passing is impossible, but even an optimistic strategy for success would require decisive wins over multiple federal election cycles. Anyone telling you Sanders’ Medicare for All plan has any chance of coming close to being adopted in 2021 is simply not being honest.