I am beginning to hate the word "pragmatic."

[Gothmog]

92. Here’s One Big Problem With The Bernie Sanders Plan For Health Care Utopia

This plan will not be adopted nationally http://www.huffingtonpost.com/entry/bernie-sanders-health-plan_us_569ff110e4b076aadcc50807

The Bernie Sanders health care plan, which the Vermont senator released this week, sounds pretty spectacular at first blush. It’s a proposal to create a single-payer system, which means that Sanders would wipe away existing insurance arrangements and replace them with a single government program. Everybody would get insurance, free of co-pays or deductibles.

That’d be an upgrade in benefits, even for seniors on Medicare. And while people would have to pay higher taxes, Sanders claims most people would come out ahead financially because they wouldn’t be paying private insurance premiums anymore. A typical middle-class family would save about $5,000 a year, according to a rough analysis commissioned by Sanders' presidential campaign, while society as a whole would end up saving something like $6 trillion over the next decade.

To help pay for his plan’s unprecedented benefits, Sanders proposes to extract unprecedented savings from the health care system. Here is where the details get fuzzy and hard to accept at face value, even beyond the usual optimistic assumptions that figure into campaign proposals. Sanders expects a large portion of the savings to come from reductions in administrative waste, because insurance billing would basically end. Another big chunk would come from squeezing the industries that produce health care services and supplies -- and squeezing those industries hard.

That last part should set off alarm bells for anybody who remembers the fight to pass the Affordable Care Act. Two particular episodes from 2009 -- one widely publicized, one barely noticed -- are a reminder of how much power those groups wield in Washington. For Sanders to realize his vision for single-payer health care, he’d have to overcome even greater resistance than Obamacare’s architects faced. And Sanders has offered no reason to think he could do that, which is something Democratic voters might want to keep in mind.

Two lessons from Obamacare

The first and better-known episode from 2009 was the battle over the “public option” -- a proposal, crafted by Yale political scientist Jacob Hacker, to create a government-run insurance plan that would compete with private insurers for customers. Hacker and others figured the public option could dictate lower payment rates to suppliers and providers of medical care, just like Medicare does, thereby keeping premiums low and forcing private insurers to match them.

Voters liked the idea, according to polls, and experts had certified that it would save the government money. But it ran into huge opposition -- not just from insurers, who didn’t want the competition, but from doctors, makers of drugs and medical devices, and hospitals, all of whom understood the proposal would cut into their revenues....

Bernie's vision vs. Hillary's

No, this grim political reality doesn’t mean Sanders or anybody else should stop advocating for single-payer. Progressive achievements like the minimum wage and civil rights began as ideas that the political establishment once dismissed as loopy. And the kind of reform that Sanders envisions would have a lot going for it. Single-payer works quite well abroad and a version of it could work here too -- even if, as Harold Pollack and Matthew Yglesias noted recently at Vox, it would ultimately require compromises and trade-offs that supporters rarely acknowledge.

But voters comparing Sanders and Hillary Clinton, who has proposed bolstering the Affordable Care Act rather than replacing it, should be clear about the choice they face. This isn’t a contest between a candidate who can deliver health care nirvana and one who is willing to settle for less. It’s a contest between a candidate imagining a world without political or policy constraints, and one grappling with them; between a candidate talking about what he hopes the health care system will look like someday, and one focused on what she can actually achieve now.