Crowded into the clown car of presidential hopefuls, only Julian Castro, Tulsi Gabbard, Andrew Yang, and the man himself, Bernie Sanders, remain committed to Medicare for All.

In January, Kamala Harris briefly backed the plan, but her initial support resulted in a deafening backlash from billionaires like Michael Bloomberg and Howard Schultz (who told CBS, “That’s not correct. That’s not American.… What industry are we going to abolish next? The coffee industry?”), and her press secretary quickly reassured critics that she would settle for “more moderate” reforms. (She has yet to articulate exactly what that means.) She’s not the only candidate to reverse on Medicare for All, with Cory Booker now endorsing an expansion of Medicare down to age 55 although he, too, had initially supported Bernie Sanders’s bill. Both Kirsten Gillibrand and Elizabeth Warren have endorsed Medicare for All, but are hedging their bets by simultaneously supporting more “moderate,” competing health care legislation in the Senate. Pete Buttigieg and Amy Klobuchar are looking at compromises but have yet to settle on an exact plan; Jay Inslee and John Hickenlooper have gone to the mat for a public option; and former health care financier John Delaney has designed his own Byzantine program from scratch, although he seems to spend the bulk of his time attacking Medicare for All as unrealistic and fiscally irresponsible.

Beto O’Rourke, for his part, has gone from endorsing Medicare for All to endorsing the misleadingly named Medicare for America, a public option policy borne of several years of research from the Center for American Progress. With his support, it has quickly become the most popular moderate plan du jour. It’s even being touted as a “pathway” to Medicare for All, even though it’s really just a fine-tuned, slightly more comprehensive version of what we already have: It would put more Americans on a Medicare program, but the rest would still be required to purchase health insurance, either through their employers or privately. The plan would also introduce more government regulation to health care giants that charge wildly inflated prices for services and medication. This might sound like an improvement, but in fact, a comparable system already exists, in the Republic of Ireland, where it’s created a crisis of care.

The problems are all too recognizable to Americans. Today, the Irish system blends public and private: There’s an (allegedly) expansive public system for the poor, alongside an additional, partially subsidized private system for those who can (allegedly) afford it. To get an Irish Medical Card, which provides coverage under the public system, an elderly person who lives alone has to make less than €500 (about $565) a week. There’s a whole other menu for adults, families, and children, but if you’re single and under 70, you have to make less than €184 a week ($208) to qualify. Hundreds of thousands fall through the cracks in Ireland’s system, too wealthy to get comprehensive benefits from the public system, but too poor to pay for private insurance entirely out of pocket.

Patients aren’t the only people suffering. I visited Ireland in January, where the Irish Nurses and Midwives Organisation—at 40,000 strong, the largest union of nurses and midwives in Ireland—had just started striking and picketing for 24-hour periods (the dispute has yet to be resolved). Their pay is so low that many have had to go to other countries for work, leaving hospitals understaffed, with patient-to-nurse ratios dangerously above recommendations, and waiting times for emergency service rated the worst in all of Europe, far worse than in countries with more comprehensive plans. As one picketing nurse I spoke to outside the Rotunda Hospital in Dublin told me, “You can’t get good care if you don’t invest in nurses’ pay, and you can’t keep Irish nurses in the country if we can’t afford the rent.”