Bernie Sanders is right about one thing; Medicare-for-All isn’t some loony leftist raving he stole from “The Communist Manifesto.” While the Sanders plan is both more expansive and expensive than any other single-payer system with which I am familiar, the concept of single-payer is more mainstream, on a worldwide basis, than our current system. If you were designing a system from scratch, it is the model you would probably adopt. The debate over it among Democrats is consequently purely tactical and practical.
The state of that debate, at this point, is rather disheartening. Proponents of the more modest public option have framed the issue as one of consumer choice, because depriving people of choices doesn’t poll well. Sanders and Warren have responded by arguing that no one actually loves his insurance company. That is both accurate and beside the point.
As I’ve noted before, the real issue with the Sanders plan is risk aversion, both for the Democratic Party and the electorate. The party knows that sweeping health care reform has been a big vote loser in 1994, 2010, and 2018, that single-payer will be resisted ferociously by a coalition of providers, insurance companies, and right-wingers, and that eliminating private insurance polls poorly. The electorate is concerned that the new system would be worse than the existing one, either as a result of human error, excessive cost, provider resistance, or GOP sabotage. That fear is both real and perfectly reasonable.
Sanders and Warren have the burden of somehow showing that the benefits of Medicare-for-All are worth the risks described above. Until we have a discussion which actually revolves around that issue, and not whether people love their existing insurance, no one is going to be persuaded by anything that is said during the debates.