Democratic presidential candidate Sen. Bernie Sanders (I-Vt.) at a county meeting in Pottawattamie, Iowa, on Jan. 19. (Andrew Harnik/Associated Press)

Regarding the Jan. 19 news article “Clinton-Sanders contest pits pragmatism vs. idealism”:

Sen. Bernie Sanders (I-Vt.), a candidate for the Democratic nomination for president, wants to take insurance companies out of the health-care business and establish “Medicare for all.” He does not seem to realize that while Medicare’s rules about eligibility, coverage and providers are established in Washington, the running of Medicare’s services and relations with providers are carried out by insurance companies (referred to as Medicare Administrative Contractors). 

Moreover, 31 percent of Medicare enrollees last year voluntarily signed up for Medicare Advantage Plans, which are run by private insurance companies that arrange for all the covered services at low premiums.

Getting rid of private insurance companies sounds good and simple, but unless the federal workforce is massively increased, those companies would be needed to run any Medicare-for-all program.

Lucia S. Hatch, Washington

The writer is an insurance company consultant and accreditation surveyor.