In what was already a deeply polarized race, few issues divided the Democratic primary field quite like health care reform. Misleadingly, at least for many voters, the debate has masked itself as being about policy, framed around questions like “should people be given the option to choose between a private insurance plan and a government one?” and “what about existing plans secured by unions in collective bargaining?”

At times, the debate also appeared to be one of strategy, constituting the most significant front in what many liberals saw as a wider battle pitting savvy pragmatism against left-wing purity.

Seen in these terms, the position championed by Bernie Sanders — which loudly put Medicare For All (M4A) front and center as an unqualified demand — was, at best, crudely maximalist and naive about the opposition any meaningful push for nationalized health insurance would face in Congress. The sensible, realist position lay somewhere between the Affordable Care Act (ACA) and M4A.