CASE STUDY: The Ethics of Strategic Ambiguity over Medicare for All
Vermont Senator Bernie Sanders has long supported a federal healthcare program for all Americans and, to this end, has proposed five “Medicare for All” (MFA) bills over the course of his tenure in Congress. During his 2020 Democratic primary campaign, Sanders frequently spoke about MFA, reminding voters that he “wrote the damn bill.” However, Sanders’ MFA bill lacked critical details, such as a strategy to pay for the multi-trillion-dollar plan.
Democratic candidate and Massachusetts Senator Elizabeth Warren also supported MFA. Warren was known as a candidate with a “plan for everything.” However, Warren struggled to commit to many specifics regarding MFA, at times aligning herself with Sanders’ MFA bill while simultaneously saying she “support[ed] a lot of plans,” including more moderate proposals (CBS News Twitter, September 13, 2019). “Right now, what we’ve got in MFA is a framework” said Warren at a September 2019 event (Kasparian, 2019).
Entering fall 2019, polls showed Warren periodically leading Sanders by ten points or more at times (realclearpolitics.com, October 8, 2019). However, Warren’s lack of details about MFA ran counter to her image as a candidate with detailed plans, which left her open to attack from opponents. For instance, former South Bend, Indiana Mayor Pete Buttigieg called out Senator Warren on her contradictory behavior by saying “Your signature, senator, is to have a plan for everything. Except [MFA]” (Kurtzleben, 2020). Even as Warren rose to the top of the polls, some criticized her for her unwillingness or inability to describe how to pay for MFA. Many progressives were concerned that Warren’s support of more-moderate proposals represented deeper ideological differences. Others saw Warren’s support for MFA as a deceitful ploy to gain support from progressives by using the name of a popular policy while planning to support a more moderate healthcare plan if elected (Kasparian, 2019).
In November 2019, Warren released a detailed MFA proposal. With the release of her MFA plan, Warren no longer appeared vague and noncommittal on MFA. Instead, her proposal’s specificity stood in contrast to Sanders’ more-ambiguous MFA bills. Specifically, Warren’s proposal included plans to raise the 20 trillion dollars that many argued was needed to pay for the program—something Sanders failed to address. Larry Levitt, the executive vice president for health policy at the Kaiser Family Foundation, called it “the most specific plan for Medicare for All that’s ever been proposed by a candidate” (Kaplan, 2019). Almost immediately, however, Democrats from across the political spectrum criticized Warren’s plan. Progressives saw the plan as “insufficiently radical” while many moderates felt that Warren’s plan, which called for sweeping changes to the tax and healthcare systems, was unlikely to pass Congress (Alter, 2020). The details also exposed Warren to new attacks from both the media and her political rivals, including eventual Democratic nominee and former Vice President Joe Biden, who criticized Warren’s plan by saying it would raise taxes on the middle class.
Warren’s poll numbers plummeted, and by the first of the year she found herself trailing Sanders by four points (realclearpolitics.com, January 1, 2020). Warren had received more criticism for her detailed MFA plan than Sanders received for his ambiguous plan. As criticism mounted and support slowed, Warren shifted her rhetoric by deemphasizing MFA (Ax, 2019). Shifting emphasis could not save her faltering campaign, however, and after a poor Super Tuesday performance, Warren withdrew from the race. Although a number of factors led to Warren’s poor performance, the attacks on her MFA plan played a significant role.
Both Warren and Sanders sought to appeal to progressives and touted similar visions of MFA, yet the trajectory of the two campaigns dramatically diverged. Early on, both Warren and Sanders made vague healthcare promises, yet Warren received more criticism for this ambiguity than Sanders. When Warren released her detailed MFA proposal, every part of her plan was torn apart. Sanders, on the other hand, publicly refused to release specific plans and received little pushback as he cited false numbers in the trillions (Luthra, 2020). While Warren was berated for MFA and subsequently slumped in the polls, Sanders, who centered his campaign around MFA, emerged from the fray to become the face of Democratic progressives. What happened?
Some, like Neera Tanden, president of the progressive think tank Center for American Progress, saw Warren as the victim of sexist expectations. “The fact that Warren paid a penalty for laying out the specifics of her MFA plan and that Senator Sanders has never paid such a penalty is a sign of the challenges women face at this moment in politics” said Tanden (Sarlin, 2020). Others contended that Warren should not have cast herself as the “plans for everything” candidate if she did not have a healthcare plan. Still others took issue with Warren’s deviations from Sanders’ vision, like her drawn-out implementation plan and an “employer contribution” funding strategy.
Is being specific in their promises a virtue for political candidates? On one hand, specific campaign promises provide voters with clear explanations of a candidate’s ideas. Voters can then hold candidates accountable for their campaign promises. Additionally, detailing policies demonstrates that candidates have thoughtfully considered the steps necessary to concretely implement their ideas. On the other hand, candidates are more likely to break their promises when committing to specifics, given the uncertain and compromise-filled world of governance. Furthermore, presenting policy details can expose a candidate to a host of new criticisms. By disclosing the specific details of her MFA plan, Warren opened herself up to more criticism by her opponents; Biden could not have attacked Warren’s plans to raise taxes had Warren remained ambiguous about how she would pay for her proposal.
Additionally, research indicates that ambiguity rarely repels, and can actually attract, voters (Tomz, 2009). When candidates are ambiguous, voters tend to believe what they want to believe about the candidates’ policies. As a result, voters often project their policy desires onto their favorite candidates. Conversely, fully fleshed out policies often fail to live up to voters’ high expectations. For example, Warren’s ambiguity permitted both her moderate and progressive supporters to project their policy preferences onto her. Sanders and Warren had always differed on particular policies, but once Warren revealed the specifics of her plan, the differences were made clear and neither moderates nor progressives were satisfied. Warren’s (eventually) more detailed rhetoric may have cost her votes and thus hurt her ability to implement her campaign promises. Broad promises and idealistic visions of the future may be more effective, even if they seem less honest because they are intentionally vague.
If vague promises are more effective in a campaign than specific plans, candidates may be encouraged to make bold promises that have little chance of being implemented. For example, MFA may not have the support of a majority of members of congress despite its political popularity (Sarlin, 2020). Given MFA’s unrealistic nature, perhaps neither Warren nor Sanders were justified in their bold promises regarding the policy. On one hand, Warren may have acted more ethically when she presented her plans to make her ambitious policy a reality, even if it hurt her chances of gaining a national platform from which to promote her ideas. On the other hand, given the significant challenge of sticking to detailed MFA policy promises, perhaps Sanders acted more ethically by remaining vague on MFA. Since he promised less, Sanders, if elected, would have possessed more flexibility when enacting policy. Still, it may have been unethical for Sanders to make MFA a central element of his campaign despite its dubious chances of implementation.
These challenges can only be approached after first establishing a shared understanding of the purpose of campaign promises. One view is that campaign rhetoric should express the values of the candidate. When asked about vague health care campaign promises, one political veteran who worked on the Affordable Care Act said, “For most of us, most of the time, policy details are proxies for other things: Does this person care about people like me? Does this person talk about values the way I talk about values” (Leonard, 2020)? Grand promises at least reveal what a candidate values and hopes for, even if attaining these goals after election might prove illusive.
Voters tend to focus more on values than they do policy details. Voters want to know whether candidates’ concerns align with their own. If issues function as proxies for particular views of the world, are detailed policy proposals needed at all during campaigning? When Sanders or Warren commit to MFA, are they promising to implement a certain policy, or are they communicating an important value: that they care about whether or not everyone has access to healthcare?
- Do campaign promises serve as policy commitments or as expressions of values?
- As the candidate with a “plan for everything,” should Warren have been held to a higher standard of specificity? Alternatively, should the bar for specificity be set based on where a candidate sits in the standings? Should the bar be equal for all candidates?
- Is it ethical for a candidate to attack an opponent’s specific plans with vague criticism? Similarly, must a candidate have detailed plans of their own if they wish to attack an opponent’s plans?
- Is it ethical for candidates to leverage ambiguity so as to allow voters to project their policy desires onto themselves?
- Is the media obligated to equally critique the campaign promises of all the candidates in a race? Can the media be held to such an expectation during a crowded race like the 2020 Democratic primary? How should the media divide limited airtime?
Alter, C. (2020, March 3) “What Went Wrong for Elizabeth Warren.” Time. Available at: https://time.com/5793943/what-went-wrong-for-elizabeth-warren/
Ax, J. (2019, December 18) “Seeking fresh momentum, Democrat Warren recalibrates ‘Medicare for All’ rhetoric.” Available at: https://www.reuters.com/article/us-usa-election-warren/seeking-fresh-momentum-democrat-warren-recalibrates-medicare-for-all-rhetoric-idUSKBN1YM2KY
Kaplin, T., Goodnouch, A., & Sanger-Katz, M. (2019, November 1) “Elizabeth Warren Proposes $20.5 Trillion Health Care Plan.” Available at: https://www.nytimes.com/2019/11/01/us/politics/elizabeth-warren-medicare-for-all.html
Kasparian, A. (2019, November 29) “Elizabeth Warren’s vagueness on ‘Medicare for All’ isn’t fooling anyone.” The Hill. Available at: https://thehill.com/opinion/campaign/463577-elizabeth-warrens-vagueness-on-medicare-for-all-isnt-fooling-anyone
Kurtzleben, D (2020, March 6) “She Was Focused And Full Of Plans But Unable To Break Through.” NPR. Available at: https://www.npr.org/2020/03/06/812670609/she-was-focused-and-full-of-plans-but-unable-to-break-through
Leonard, Kimberly (2020, January 16) “When campaigning on health care vagueness is the smart political move.” Washington Examiner. Available at: https://www.washingtonexaminer.com/policy/healthcare/when-campaigning-on-healthcare-vagueness-is-the-smart-political-move
Luthra, S. (2020, February 25) “Bernie Sanders embraces new study that lowers ‘Medicare For All’ price tag, but skepticism abounds.” Politifact. Available at: https://www.politifact.com/factchecks/2020/feb/26/bernie-sanders/research-exaggerates-potential-savings/
Sarlin, B. (2020, March 5) “Why ‘Medicare for All’ Wrecked Elizabeth Warren but not Bernie Sanders.” NBC News. Available at: https://www.nbcnews.com/politics/2020-election/why-medicare-all-wrecked-elizabeth-warren-not-bernie-sanders-n1150691
Tomz, M., Houweling, V,. & Robert, P. (2009) “The Electoral Implications of Candidate Ambiguity.” American Political Science Review, 103 (1), 83-98.
Jason Rucker & Scott R. Stroud, Ph.D.
Project on Ethics in Political Communication / Center for Media Engagement
George Washington University / University of Texas at Austin
August 12, 2020
This case study was produced by the Media Ethics Initiative and the Project on Ethics in Political Communication. It remains the intellectual property of these organizations. It is supported by funding from the John S. and James L. Knight Foundation. This case can be used in unmodified PDF form for classroom or educational uses. For use in publications such as textbooks, readers, and other works, please contact the Center for Media Engagement.