The fourth Democratic debate: Head vs heart, pragmatism vs passion

Bernie Sanders says he wants to enact universal health care – or, as he calls it, “Medicare for all.” That is indeed a splendid aspiration, right up there with world peace and unicorns gamboling in the grass.

Forgive my skepticism, but a ’70s Steely Dan lyric springs to mind: A world become one/ Of salads and sun / Only a fool would say that.

I don’t mean to suggest that Bernie is a fool. Only that much of what he says is politically foolish.

As evidenced anew in last night’s Democratic debate – disgracefully scheduled on a weekend, yet again, to inexplicably minimize viewership – Bernie is big with liberals because he dreams big. He’s currently giving Hillary Clinton fits, fighting her to a draw in Iowa and New Hampshire, because he tugs at the heart, stoking visionary passion. Whereas Hillary points out that politics is the art of the possible. That’s not a sexy message, not at a time when so many Democrats (especially Bernie’s young white liberals) prefer to dream of new possibilities.

This stark contrast was most vividly illustrated during last night’s clash over health care. Hillary said that she wants “to build on the Affordable Care Act, to improve it.” But Bernie said that Obamacare doesn’t go far enough, that the imperfect should be replaced by the perfect – that private health insurers should be thrown out, and replaced by government (“single payer”) coverage. In his words:

What a Medicare-for-all program does is finally provide in this country health care for every man, woman and child as a right. Now, the truth is, that Frank Delano Roosevelt, Harry Truman, do you know what they believed in? They believed that health care should be available to all of our people….My proposal, provide health care to all people, get private insurance out of health insurance, lower the cost of health care for middle class families by 5000 bucks. That’s the vision we need to take.

Hey, it’s great to have a vision. Problem is, Bernie’s vision is DOA in the real world of congressional politics – as Hillary rightly pointed out:

(T)he Democratic Party and the United States worked since Harry Truman to get the Affordable Care Act passed….I don’t want see us to start over again with a contentious debate. I want us to defend and build on the Affordable Care Act and improve it….That (law) is one of the greatest accomplishments of President Obama, of the Democratic Party, and of our country. And we have already seen 19 million Americans get insurance. We have seen the end of pre-existing conditions keeping people from getting insurance. We have seen women no longer paying more for our insurance than men. And we have seen young people, up to the age of 26, being able to stay on their parent’s policy. Now, there are things we can do to improve it, but to tear it up and start over again, pushing our country back into that kind of a contentious debate, I think is the wrong direction.

Bernie persevered, and again pitched his pie in the sky:

We’re going to go forward….The vision from FDR and Harry Truman was health care for all people as a right in a cost-effective way. We’re not going to tear up the Affordable Care Act. I helped write it. But we are going to move on top of that to a Medicare-for-all system.

Oh really? Pray tell, how would President Bernie propose to push Medicare-for-all through the House of Representatives – which is virtually guaranteed to remain in Republican hands until, at minimum, the early 2020s? And how would he conceivably persuade the Senate to pass his dream – unless the chamber is run by a filibuster-proof Democratic majority (a long shot anyway)?

Again, Hillary had to remind everyone about reality – about politics as the art of the possible. Even in ’09 and ’10, when the Dems dominated both chambers, single-payer health care couldn’t pass:

(D)uring the Affordable Care Act debate, there was an opportunity to vote for what was called the public option. In other words, people could buy in to Medicare, and even when the Democrats were in charge of the Congress, we couldn’t get the votes for that. So, what I’m saying is really simple. This has been the fight of the Democratic Party for decades. We have the Affordable Care Act. Let’s make it work….

She’s talking about the slow and steady incrementalism, but that doesn’t stir the emotions. It’s way easier, in the current anti-establishment climate, to conjure visions – even if there’s no chance that such visions can be brought to fruition.

Bernie’s health care dream sounds pristine when voiced at a debate podium, but imagine what would happen if it were fed through the congressional grinder, with Republicans and conservative Democrats cranking the lever. For starters, a new single-payer crusade would suck up so much oxygen, and so much time, that nothing else would get done. Bernie should know this; after all, he’s been on Capitol Hill far longer than Hillary ever was.

There’s more. Bernie said last night that, under his single-player plan, middle-class folks will “pay a little bit more in taxes” to get cheaper insurance. Swell. Rest assured that his congressional foes would market that as BERNIE’S MIDDLE CLASS TAX HIKE. Heck, if he’s the nominee this fall, rest assured that Republicans will mass-market that as proof of his “socialism.” (His electability polls look good right now because Republicans have barely touched him. Yet.)

But, for now, one thing is clear: This Democratic race is a choice between heart and head. It’s Hillary’s burden to be stressing the latter.

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