The Editorial Board

USA TODAY

In the 1990s, Democrats offered up a health care overhaul that was big and complex and would have affected nearly every American in profound ways. The plan died in Congress, largely because of opposition from people who were reasonably satisfied with the status quo and didn't want to blow up the system.

A decade and a half later, Democrats would try again, this time with a plan that would allow individuals without coverage to buy it on newly created exchanges while leaving everyone else pretty much alone. That plan, known formally as the Affordable Care Act and informally as Obamacare, passed because Democrats briefly held a filibuster-proof majority in the Senate. And even though it drew heavily from a conservative proposal in the 1990s, Republicans have made repealing it a priority ever since.

The obvious lesson here is that even modest health care changes are a struggle to get and to retain. But that seems lost on the left wing of the Democratic Party. Led by Sen. Bernie Sanders of Vermont, many are infatuated with a remake of health care far more radical than any in the past. As a result, health care is shaping up as one of the biggest issues in the 2020 primaries and general election.

Sanders’ plan, dubbed “Medicare for All,” would eliminate private insurers and have all Americans covered through Medicare. It would be far more generous than most current plans — covering dental, vision and mental health, among other things — and would be financed largely by taxes on the wealthy.

Would it be an improvement? Hypothetically yes, particularly if the nation were starting from scratch. The current system is hugely expensive for individuals and companies, generates mountains of paperwork, and keeps people tied to their jobs for fear of losing employer-subsidized coverage.

BERNIE SANDERS:Medicare for All will save Americans from health care crisis

But Sanders’ plan has intrinsic drawbacks, most notably its soak-the-rich approach and its lack of cost controls such as copays. What stands out is the utter impracticality of getting from where things stand today to what he proposes.

In an era of intense political polarization, no measure that disrupts insurance for more than 100 million Americans, most of them reasonably satisfied with their coverage, would get through Congress. Even if Democrats managed to reclaim the supermajority they once had, many in their own ranks would balk once they began focusing on the mechanics of leaping from today’s fragmented system to a single-payer system in one fell swoop.

The nonpartisan Congressional Budget Office, which has long been the gold standard for estimating the cost of legislation, looked at Sanders’ plan and decided there were too many unknowns to produce a hard number. But CBO did say that implementing it would be “complicated, challenging and potentially disruptive.”

The combination of generous benefits and lower payments to health care providers could create "a shortage of providers, longer wait times and changes in the quality of care," CBO warned last week.

Democrats would do better by focusing on a more gradual game plan. Several proposals, for instance, would allow some or all Americans not yet 65 to buy into Medicare at cost or slightly above, rather than at the highly subsidized rate enjoyed by seniors. All would retain private insurance as an option.

These plans could apply only to people approaching retirement, as is the case with the self-explanatory “Medicare at 50 Act.” Some proposals would mean that people on the individual exchanges could buy in. At least one would allow people on exchanges and people with employer-sponsored coverage to chose Medicare.

None of these incremental approaches lends itself to bumper stickers, placards or campaign rallying cries. None is without consequences and potential pitfalls. Even so, they represent far more practical approaches than lurching from the present into Bernie Sanders’ idea of what our national health care system ought to look like.

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