Everybody seems to be talking about how the Democratic Party is moving to the left these days in response to an increasingly aroused base. I’m happy about that, but I do worry about some of the policy proposals that come from the left. “Medicare for all” has become practically a mandatory position for any Democrat claiming progressive credentials. In his opinion newsletter yesterday, the Times’s David Leonhardt voiced some useful warnings about this trend.

To be clear: I don’t doubt that some version of a single-payer health insurance system, typified by Medicare for all, is objectively the best, most cost-effective way to deliver health care. The problem is: getting there is politically tricky. About half of Americans get their health insurance through their employers, and the great majority of these express substantial satisfaction with this arrangement. Tell them that you’re going to replace their employer plan with a different, government-sponsored one and you’re going to make them nervous. As Leonhardt points out, poll results that show strong majority support for Medicare for all collapse when respondents are told that they would be required to give up their existing insurance. Sure, you can explain how Medicare will serve them just as well, and how Medicare for all will be better for the country, but you will still make them nervous. I don’t want to make voters nervous about Trump’s 2020 opponent.

Thankfully, there are plenty of different approaches to Medicare for all, some of which don’t involve wiping out private insurance. I agree with Leonhardt that Democrats should keep the idea but formulate it carefully. He advocates talking points along these lines:

I’m for Medicare for All. If you want Medicare, you can have it, regardless of your age. If you’d rather keep your private plan, you can do that, too. This approach will give us universal coverage, lower costs and consumer choice. Oh, and I’m in favor of tax increases on the wealthy and corporations to help pay for it.”