HEALTH-care policy has become one of the most glaring areas of disagreement between Hillary Clinton and Bernie Sanders in the campaign for the Democratic presidential nomination. In last week’s debate, the two leading contenders laid out starkly different visions, with Mr Sanders taking a pie-in-the-sky approach while Mrs Clinton cemented herself as a pragmatic incrementalist. After a Republican debate a few days earlier in which the discourse over health-care amounted to the rather empty mantra of “repealing and replacing” Obamacare—without a single detail from any of the contenders on what a replacement might entail—the Sanders-Clinton exchange was refreshingly substantive. The first mention of health-care came in the candidates’ opening statements, when moderator Lester Holt of NBC News asked which “top three priorities” the candidates would pursue in their “first 100 days in office”. For Mr Sanders, the no-holds-barred leftie, this was the ideal lead-off question. “Well, that's what our campaign is about”, he noted, chomping at the bit. “It is thinking big. It is understanding that in the wealthiest country in the history of the world, we should have health-care for every man, woman, and child as a right”. This is the kind of rhetoric that has ignited surprisingly large and vocal crowds for the socialist senator from Vermont over the past few months and ushered him to a position no one expected: he is now neck-and-neck with Mrs Clinton in Iowa and appears to be walloping her in New Hampshire. When it was her turn, Mrs Clinton served up the equivalent of a four-square sensible dinner, sans dessert: “I would...present my plans to build on the Affordable Care Act and to improve it by decreasing the out-of-pocket costs by putting a cap on prescription drug costs; by looking for ways that we can put the prescription drug business and the health insurance company business on a more stable platform that doesn't take too much money out of the pockets of hard-working Americans”.

The more detailed exchange that followed was a study in caricatures: lofty principle vs. mannered pragmatism, unreconstructed liberalism vs. cautious bipartisanship, shoot-for-the-moon vs. settling for grounded compromise. The Sanders style obviously plays much better in a debate and stirs quite a bit more emotion in the Democratic party base, while Mrs Clinton’s style reflects years of struggle and disappointment with grander measures that have failed when the political reality of Washington, DC intervened. So while she insisted off the bat that she is “absolutely committed to universal health-care”, Mrs Clinton quickly dialed back from that position. “I have worked on this for a long time”, she said, without quite sounding hard-bitten. “People may remember that I took on the health insurance industry back in the '90s, and I didn't quit until we got the children's health insurance program that ensures eight million kids”. Rather than “tear [Obamacare] up and start over again”, Mrs Clinton pleaded, let’s “defend and build on the Affordable Care Act and improve it”. Mr Sanders’ radical measure to insure all 320m Americans is just a non-starter. “I don't to want see us start over again with a contentious debate”, she said twice.

As red-meat applause lines go, “let’s not have contentious debate”—uttered sternly in the middle of a contentious debate—is not high on the list. And Mr Sanders made the most of his much more radical approach to health-care, which would, as his website makes plain, revolutionise the American health-care system: “Health-care must be recognized as a right, not a privilege. Every man, woman and child in our country should be able to access the health-care they need regardless of their income. The only long-term solution to America's health-care crisis is a single-payer national health-care program”. In the debate, Mr Sanders sketched a noble pedigree for this idea: “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”.

Here Ms Mitchell called the Vermont senator on how he would be able to push through such a plan in a country where exceedingly more modest measures are still unpopular. Noting that universal health-care failed to attract sufficient support even in the liberal haven of his home state, Ms Mitchell pressed him to explain “how can you sell it to the country...if you couldn't sell it in Vermont”. In a revealing double-pivot, Mr Sanders first drew laughter by reminding the audience that he’s just a senator from Vermont, not its governor. Then he blamed the dim prospects for radical change in health-care policy on the main bogeyman of his presidential campaign: a “campaign finance system that is corrupt”. He may be right about that. But he provided no persuasive account of how, as president, he would manage to transform the way elections are funded.

The debate isn’t about numbers. Mrs Clinton correctly notes that about 19m more Americans are covered under Obamacare; Mr Sanders is right that this still leaves about 30m Americans uninsured. The dispute between the leading Democrats is over what to do about the remaining 10% of the country at risk of financial ruin or worse, should an unwelcome diagnosis crop up. There is little doubt that insuring everybody is a laudable goal. But Mrs Clinton is right that the political constraints on implementing a plan to do that are more formidable than one charismatic liberal president could overcome. As Paul Krugman of the New York Timeswrites, whatever the virtues of a single-payer system, “it’s just not going to happen anytime soon”. The real question about Mr Sanders' plan, along with his overall devil-may-care approach to public policy, is whether ignoring political realities is enticing enough to Democrats to earn him a spot on the ballot in November. And the question for steady-as-she-goes Mrs Clinton is whether her sensible shoes may trip her up in a primary season where voters seem decidedly uninterested in wonkishness and modest proposals.