Senator Bernie Sanders is getting a lot of heat from political establishment types for proposals they view as outlandish. The top of the list is breaking up the big banks and universal Medicare. The complaint is that these proposals are so far off the political agenda, Sanders is wasting everyone’s time by raising them

It is understandable that the interest groups who profit from the current situation do not want to see it altered. But that doesn’t mean we are condemned to have incredibly wasteful financial and health care systems forever.

Starting with finance, we actually have already seen some breakups of large financial institutions in the wake of the Dodd-Frank financial reform bill. GE is seeking to offload its financial services division. Citigroup has also downsized by selling off some divisions. The Financial Stability Oversight Council established by Dodd-Frank currently has the authority to breakup too big to fail banks.

To continue down this direction will require political will, which presumably a President Sanders would provide. But the idea of downsizing systemically important banks and other financial institutions is already in law; we just need a stronger hand in pushing forward.

There is a similar story with the Affordable Care Act (ACA) and universal Medicare. The ACA was a huge step forward in extending coverage and controlling costs, however we still have far to go before we reach universal coverage and bring our costs in line with other countries.

While it is unrealistic to think that we could switch from our current system to some sort of universal Medicare system overnight, it is not implausible that we could take large steps in that direction. For example, we could allow people over the age of 55 to buy into the Medicare system.

By continually raising the issue of universal Medicare, and pointing out the extent to which the public is getting ripped off by the health care industry, Sanders is building the sort off public pressure that is needed to allow reform to move forward. This is essential in a context where the industry groups all have their lobbyists pushing for more money, while the public has no lobbyist for lower costs and increased access. The sort of public anger aroused by Sanders is hardly a diversion, it will be essential for further progress on health care reform.

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