The Democratic primary has been unexpectedly dominated by a single question: Will you abolish private health insurance?

Wrapped in that question are dozens more. Why, if private health insurance is such a mess, do polls show most Americans want to keep it? What lessons should we take from the failure of past efforts at health reform? What does it mean to say “if you like your health insurance plan, you can keep it?”

Matt Bruenig, the founder of the People’s Policy Project, is firmly in support of true single-payer. No compromise, no chaser. He’s frustrated by those, like me, who try to work around the public’s resistance to disruptive change, who treat past failures and current polls as predictions about the future. And, in turn, I’m often frustrated by Matt’s tendency, mirrored by many on the left, to treat people with similar goals but different theories of reform as villains and shills.

In this podcast, Matt and I hash it out. The questions here are deep ones. When are political constraints real, and when are they invented by the people asserting their existence? If you already believe the political system is broken and corrupt, how can you entrust it to take over American health care? Can you cleave policy from politics? What would the ideal health care system look like, and why?

Book recommendations:

A Theory of Justice by John Rawls

What Is Property? by P. J. Proudhon

The Progressive Assault on Laissez Fair by Barbara H. Fried

Ezra’s recommended reading:

One Nation, Uninsured by Jill Quadagno

Remedy and Reaction by Paul Starr

It's the Institutions, Stupid! by Sven Steinmo, Jon Watts

Want to contact the show? Reach out at ezrakleinshow@vox.com

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