When Barack Obama gave his “this is it” speech on health care reform on March 3, he once again swerved out of his way to hit advocates of a single-payer system.

He said: “On one end of the spectrum, there are some who have suggested scrapping our system of private insurance and replacing it with government-run health care. Though many other countries have such a system, in America it would be neither practical nor realistic.”

You can argue about whether it is realistic politically but there should be no question whatsoever that it’s practical in the sense of being functional. It works well in other countries, including Canada, and there is no reason it can’t work well here. Canada’s health outcomes, and the health outcomes of every other advanced industrial country with government-run systems, are superior to ours.

Maybe Obama was using the “neither, nor” construction to try to strengthen his weak and illogical opposition to single-payer and even to a robust public option like Medicare for all who want it—and 65 percent of the American people do want that kind of a public option.

There is not that much difference between “practical” and “realistic” if by both he meant to say politically possible. I suppose he could have really stretched the sentence out by saying “government-run health care . . . would be neither practical nor realistic nor feasible nor possible nor doable nor achievable nor viable.” But it would all mean the same thing. At bottom, he didn’t want to expend any political capital for it, or even for the robust public option.

Instead, he exploited advocates of a single-payer system as a foil to say, in not so many words, “I’m not an extremist like they are.”

He juxtaposed them with Republicans who want to “loosen regulations on the insurances companies.” And he did so in order to try to claim the middle ground, on the false and facile assumption that the middle ground is always the best ground.

Here’s how he put it: “I don't believe we should give government bureaucrats or insurance company bureaucrats more control over health care in America.”

By damning “government bureaucrats,” Obama played right into the hands of the anti-government crowd and made any durable expansion of health care coverage all the more difficult. He also insulted every single federal employee in the Medicare and Medicaid and VA and Indian health programs.

This was reprehensible rhetoric.