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Bernie Sanders’s single-payer healthcare plan is reopening old wounds in the Democratic Party.

Democrats fought bitterly in 2008 and 2009 over the Affordable Care Act (ACA), with liberals pressing unsuccessfully for the inclusion of a “public option” that would compete with private insurance companies.

{mosads}That debate receded after the passage of the healthcare law, but it’s returning now that one of the party’s leading presidential contenders is advocating that the government provide health insurance for everyone.

Sanders is campaigning on a plan to enact universal coverage through a single-payer system, which he bills as “Medicare for all.”

While many Democrats support the idea in theory, they warn such a plan has no chance of passing Congress. Veterans of the ObamaCare debate fear that raising the prospect of a single-payer system will distract from improving the existing law — a point that Hillary Clinton raised during her debate clash with Sanders over the weekend.

“I was a little surprised to see this debate pop up again,” said Jim Manley, who worked for then Senate Majority Leader Harry Reid (D-Nev.) during passage of the healthcare law and has endorsed Clinton for president. “I would have assumed that the focus would be on efforts to improve the current healthcare system.”

Groups that fought to implement President Obama’s signature law say it’s too late to turn back now.

“I think it moves us away from an effective and practical agenda that we should be focusing on in the future,” said Ron Pollack, executive director of Families USA, a leading liberal healthcare advocacy group.

“Specifically, there are some improvements that should be made to the Affordable Care Act that I think are feasible in the not too distant future. And I think we should focus like a laser on getting those achievements.”

But while Sanders might be making some Democrats squirm, his support for a single-payer plan appears to be a political winner among the party’s primary voters.

A Kaiser Family Foundation poll last month found that a massive 81 percent of Democrats favor a single-payer healthcare system, while 52 percent “strongly” favor it. 

Wary of alienating the left, Clinton has treaded carefully when attacking Sanders’s plan, asserting that its state-based design would be open to sabotage from Republican governors and that it would require tax hikes on the middle class.

“We have accomplished so much already,” Clinton said during Sunday night’s debate. “I do not to want see the Republicans repeal it, and I don’t want to see us start over again with a contentious debate. I want us to defend and build on the Affordable Care Act and improve it.”

In defending the healthcare law, Clinton is also tying herself more closely to Obama — something that could help her with black voters, a weak point for Sanders. 

Sanders, for his part, notes that he supports and helped write the Affordable Care Act. But the healthcare system remains broken, he argues, with millions uninsured and people with coverage struggling to pay their rising deductibles and copayments. 

“No one is tearing this up, we’re going to go forward,” the Vermont senator said. “But what the secretary neglected to mention, not just the 29 million [who] still have no health insurance, that even more are underinsured with huge copayments and deductibles.”

Clinton’s criticism of a single-payer plan risks putting her out of step with the Democratic grassroots, something Sanders alluded to on Sunday when he said the former secretary of State was “sounding like a Republican.”

Still, there are major unanswered questions about Sanders’s proposal.

The self-proclaimed democratic socialist acknowledged at the debate that his plan is “not all that detailed.”

Some of the major policy questions are: What rates would the new government-run insurance system pay to doctors and hospitals? And would the system cover every possible health procedure or service, or would some things be denied?

Sanders’s policy director, Warren Gunnels, wrote in an email to The Hill that “the U.S. Department of Health and Human Services would establish those rules.” He added that the rules and procedures would be “similar to the current Medicare program.”

Sanders’s plan states that the new system would have no co-pays or deductibles. The combination of covering a wide range of services and not asking consumers to chip in for them out of pocket could encourage heavy use of health services and drive up costs, experts say.

“It is not throwing unfair charges to say that that would be a deeply inflationary structure,” said John McDonough, who served as senior adviser on national health reform to the Senate Health Committee during passage of the ACA. 

Sanders’s plan projects it can save $6 trillion over 10 years, in part by cutting out wasteful administrative costs and driving down drug prices. 

“That’s based on more assumptions than you can shake a stick at,” McDonough said. 

Sanders’s detractors note that the ACA barely passed even when Democrats had large majorities in both chambers of Congress. Republicans are almost certain to control at least the House in 2017, making any kind of government healthcare a non-starter.

McDonough recalled meeting with a Sanders staffer in 2009, during the debate over the ACA, to discuss how much support there was for Sanders’s single-payer plan.

He said that even among Democratic senators, the number of names they could come up with to support the plan was in the “single digits.”

Pollack, of Families USA, and other liberal health experts said the focus should instead be on improving ObamaCare, for example, by giving additional financial assistance to people still dealing with high deductibles and copayments under their plans. 

“We ought to build around [the ACA], not try to go back to the drawing board on something that would not happen,” said former Rep. Henry Waxman (D-Calif.), who helped shape the law as a committee chairman. “There are other issues we have to work on too.”

“Making a speech saying we would like to have ‘Medicare for all’ is just a speech,” he added.

Tags Bernie Sanders Harry Reid Hillary Clinton

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