Health care policiy defines the difference between Sander's idealism and Clinton's pragmatism

Paul Krugman writes that "Many, perhaps most, health economists would recommend single-payer, a Medicare-type program covering everyone."   Hillary Clinton has in fact said that is what she wants in the long run.

But how to get there is where she and Sanders differ.   And this issue, as much as anything, defines the difference in their approaches to government and their campaigns for the presidency.   Sanders is promoting a grass-roots movement to overhaul the way we do things -- the economy, health care, etc.   He inspires particularly young people, who tend to be more idealistic than practical.   But he has a wider appeal to people who feel the government is working for wealthy people and corporations and not for them.

Hillary Clinton, on the other hand, is the experienced policy wonk who has concluded that you get more of what you want by compromise and making incremental changes toward your goal.    Rather than replacing Obamacare with a single payer plan, she would work to improve it, starting with restoring the public option that was in the original plan.

Obamacare is the cumbersome jumble that it is for several reasons:

1.  It was the best possible plan that was politically feasible.   Even so, it did not get a single Republican vote but was passed through a process that required only a simple majority.   A slight tip the other way, and it would have lost moderate Democratic votes.

2.  The reason private insurance and pharmaceutical companies were not scrapped is because they have powerful lobbies that would have killed the whole thing, as they did when Hillary Clinton tried to reform health care in 1993.   So this time, they brought insurance and pharma into the plan and made it worth while to them -- and got their support.

3.  A single-payer, government run health care plan will require big tax increases, as Sanders acknowledges.   His explanation -- that the taxes will be more than offset by not having to pay health insurance premiums and thus will save people money -- is very reasonable and works for me.   But in this political climate of a presidential election, there is no way that Republicans are not going to yell "raising taxes on the middle class."   And it will be hard to get people to hear the reasonable explanation.

So here's the bottom line, as Krugman summarizes:

"You might say that it's still worth trying.   But politics, like life, involves trade-offs.

"There are many items on the progressive agenda, ranging from an effective climate change policy, to making college affordable for all, to restoring some of the lost bargaining power of workers.   Making progress on any of these items is going to be a hard slog, even if Democrats hold the White House and, less likely, retake the Senate. . . .

"So progressives must set some priorities.   And it's really hard to see, given this picture, why it makes any sense to spend political capital on a quixotic attempt at a do-over, not of a political failure, but of health reform -- their biggest victory in many years."

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That seems very clear.   Why spend limited capital fighting to re-do something that was your biggest victory in many years?   Indeed.    

It might be different if we had a Democratic congress.   But, at most, we could have a slight majority in the senate.   Much as I like Bernie Sanders and want his idealism to keep pushing the Democrats and Hillary to the left, I don't think this is the time to try to overhaul everything.    Let's stick with Obamacare for a few years and try to get some of the other things done -- including Sanders' even bigger agenda of addressing income inequality and reining in Wall Street.

Ralph