Hillary at Thursday’s debate. Photo: Win McNamee/Getty Images

Hillary Clinton and Bernie Sanders have had this argument before. At least five times before to be precise. Whenever health care comes up in a Democratic debate, Hillary Clinton will tout the Affordable Care Act’s successes and then promise to incrementally expand its reach until all Americans enjoy insurance coverage. The Vermont senator then responds by noting that the ACA leaves nearly 30 million uninsured, many more underinsured, and one in five Americans struggling to afford the costs of their prescription drugs. Sanders proceeds to argue for a single-payer, “Medicare for all” system that would guarantee health care as a fundamental right.

Clinton will then, with varying levels of exasperation, reiterate that she shares Sanders’s goal of universal health-care access, but that “every progressive economist” who has crunched the numbers on his plan has found that it would cost more to implement than its new revenues would raise. Further, passing Obamacare was a nightmarish marathon of legislative grappling, and that was back when Democrats still controlled the Congress! Reopening that debate in order to pursue a fiscally dubious and politically impossible single-payer system will not help the sickest among us, Clinton suggests.

Finally, Sanders argues that the only thing that makes single-payer “impossible” is the influence of the insurance companies that his health-care plan would replace. Brushing off this or that economic analysis, the senator points to the United Kingdom, to Canada, to France — countries that have socialized medicine and lower health-care costs per capita.

Until Thursday night’s debate, Clinton had never attempted to answer this rebuttal.

“We aren’t France,” Clinton said in Milwaukee. “We inherited a system of employer-provided insurance that was set up during World War II. And so what we have tried to do, is to build on the health-care system we have.”

Clinton’s point appeared to be that when other nations established socialized health care, they didn’t have to dismantle a generations-old system of private insurance — one that a major industry, along with millions of Americans, are already invested in. In this context, Clinton argues that government reforms that subsidize and supplement this system, as opposed to replacing it, provide a more realistic path to achieving universal coverage.