To be clear, this was not to say that Sanders was standing back on the health care fight, but rather fighting a different fight. In this case, neither won particularly. Hillary’s Health Security Act garnered 103 cosponsors (Sanders not among then), but Sanders’ fight here represents his continued disconnect from the pragmatic realities that one faces when taking policies from a small state like Vermont to a national context.
The fact is, most of liberal Democrats would be thrilled to see the passage of a single-payer, universal health care system that is more emblematic of what we see in parts of Europe. Of course, the advantage of many European countries is their size: granting greater benefits with greater efficiency is easier with a more finite population than the United States has. And at the end of the day, pragmatism isn’t just an advantage at the negotiation table – it’s a necessity of governance (not to mention election to get in the door in the first place).
Were it not for the candidates both fighting for the Democratic nomination, they would be on the same team. They share a commitment to expanding health coverage for more Americans and making it easier to draw on the coverage that they have, with one candidate espousing the more realistic vision in a conflictual partisan environment and the other putting forth more liberal ideals whose implementation are less realistic. The problem is that if you ask for too much, you may get nothing. If you make a realistic request, you’ll probably get something. And that something will make the difference in who is able to see their doctor about a suspicious lump that could be malignant, for an endoscopy to rule out gastric cancers, for therapy that can help one to manage depression before it leads to suicidality and medical disability.
What we also know is that pragmatism isn’t sexy in an election season. There are times when Hillary comes off like the parent constantly having to tell her children “no” to their lofty goals, even though she is most often right. Her plan is the stuff of one who has weathered many storms and knows what can (and must) be done: expand the Affordable Care Act, reduce rising out-of-pocket costs for obtaining medical treatment, crack down on rising prescription drug costs, and protect reproductive choice. These are not game-changers, but they are necessities, and her battle scars come with the evidence of her ability to weather this storm.
There is something to be said for aspiring to greatness, and in the absence of those aspirations to greatness it becomes unlikely to achieve it. Indeed, one of the great political inspirations of the Democratic Party, Bobby Kennedy, held famously, “Some people see things as they are and say, ‘Why?’ I dream of things that never were and say, ‘Why not?’” Indeed, we should with more frequency be asking ourselves “why not?” and to Sanders’ credit, he is pushing for more of that discussion. The problem is when it interferes with the ability to achieve good governance in the face of a party working to undo all of the progress on which Clinton and Sanders both hope to build. Clinton has both the tools and the wisdom to deliver when we most need it.