With 16 Democratic senators beside him, Sen. Bernie Sanders, I-VT, introduced Medicare-for-All legislation on Wednesday, sending a message to Congress that ongoing GOP efforts to cut healthcare safety nets is unacceptable and setting a high visionary bar for 2018’s candidates and national elections.

“Under this legislation, every family in America would receive comprehensive coverage, and middle-class families would save thousands of dollars a year by eliminating their private insurance costs as we move to a publicly funded program,” Sanders wrote in a New York Times op-ed, describing a four-year transition where Medicare coverage would be expanded for current recipients, Americans over age 65, and the enrollment age lowered.

“In the first year, benefits to older people would be expanded to include dental care, vision coverage and hearing aids, and the eligibility age would be lowered to 55. All children under 18 would also be covered,” he continued. “In the second year, the eligibility age would be lowered to 45 and in the third year to 35. By the fourth year, every man, woman and child in the country would be covered by Medicare for All.”

Well-known progressive groups quickly amplified the call for a national health care system by sending out more passionate messages from Sanders, similar in tone to those from his presidential campaign.

“The truth is that the only way we will successfully transform our health care system is when we transform our political system. The two struggles go together,” Sanders wrote in an email from Democracy for America. “We will succeed when we involve millions of people in unprecedented political activity who are prepared to stand up and fight for a government that represents all of us, not just greedy powerful corporate interests. In other words, we need a political revolution in this country.”

His campaign rhetoric could also be found in tweets by Senate cosponsors of the legislation.

“Quality health care should be a right not dependent on wealth—that’s why I’m cosponsoring the Medicare-for-All Act,” said Sen. Corey Booker, D-NJ.

“We need a seamless health care system that delivers better care,” said Sen. Jeff Merkley, D-OR. “Our goal for the health care system should be peace of mind.”

“If you believe every American should have good, affordable health care, join me in supporting Medicare for All,” said Sen. Kirsten Gillibrand, D-NY.

Congressional candidates expressed similar sentiments.

“I'm running in NY11,” Omar Vaid, a House candidate, replied to Gillibrand. “Support us with some follows. We need that congressional seat to pass the Medicare-for-All bill!”

And so did progressive groups that have long supported national health care.

“This is an especially gratifying moment for the tens of thousands of nurses across the U.S. who have dedicated years of effort to transform our health care system from a profiteering industry based on greed and suffering to patient need and healing,” said RoseAnn DeMoro, executive director of National Nurses United, which has been pushing for statewide single-payer in California and been blocked by Democratic legislative leaders.

DeMoro thanked the co-sponsors of the Senate bill and noted that “a majority of House Democrats are now co-sponsoring a longtime House single payer bill, Rep. John Conyers’ HR 676, which NNU also backs.”

DeMoro argued that public support for substantive health care reform was growing and politicians should listen to grassroots organizers.

“The broad support this bill is already generating is a dramatic testament to a seismic shift occurring across the U.S. toward grassroots participatory democracy and the demand of people in communities across the nation demanding a real change,” she said. “It is this broad movement that is forcing this issue on the public agenda.”

“This is exactly the type of bold solution we need,” echoed CREDO political director Murshed Zaheed. “The fact that 16 Senate Democrats are now on the record in support of Medicare for All is clear evidence that the progressive wing of the Democratic Party has momentum… Now it is time for the rest of the Senate Democratic caucus to catch up.”

Campaign Poetry, Governing Prose

Sanders’ authority as a health care reformer is unassailable. He was calling for a national health care system before he was first elected to the U.S. House in 1990. Then, as today, he lambasted the U.S. as “the only major country on earth that allows chief executives and stockholders in the health care industry to get rich, while tens of millions of people suffer because they can’t get the healthcare they need.”

As has been the case for years, he lamented the millions of uninsured Americans, noting that Americans spend more on health care and have worse outcomes than in Canada and in Europe. Meanwhile, the federal government has passed absurd legislation forbidding most federal health programs from negotiating drug prices, which has become a corporate welfare subsidy costing tens of billions of dollars annually.

While not explicitly criticizing the Affordable Care Act, Obamacare, his Medicare-for-all proposal proposal drew on personal stories from his presidential campaign and subsequent town halls he has held in red states to try to educate voters on the issue.

“I have heard from older people who have been forced to split their pills in half because they couldn’t pay the outrageously high price of prescription drugs,” he said. “Oncologists have told me about cancer patients who have been unable to acquire life-saving treatments because they could not afford them. This should not be happening.”

But it is happening, needless to say, because America’s health care system, which represents one-sixth of the domestic economy, is deeply entrenched and has many political defenders. In 2009, when Democrats had a majority in Congress and were drafting the ACA, Sanders and other progressives made every effort to introduce language to give the government power to negotiate drug prices and offer individuals an option to buy into Medicare. In both cases, Democrats—not Republicans—blocked those reforms.

Similarly, in California this year, statewide single payer legislation drafted by the California Nurses Association passed the state Senate but was ambushed in the Assembly when that body’s top leader, a Democrat, broke his word to the CNA that the Assembly would take up the financing elements, and then sidelined the bill. That led to protests in House Speaker Anthony Rendon’s district and a recall campaign to unseat him.

The history shows that when the call for single payer moves from the campaign trail into legislative chambers, the fight gets much tougher.

Seen in that context, Sanders’ introduction of a national single-payer bill accompanied by 15 Democratic senators, raises the bar for all Democrats and candidates in 2018, the next federal election cycle. In some respects, his announcement Wednesday could be seen as opening the 2018 campaign season for progressives.

But away from the poetry of the campaign trail is the nasty business of governing. Back in Congress, Republicans hoping to advance a tax reform bill are looking to pay for it by cutting billions from health care and safety nets, wrote Sen. Elizabeth Warren (D-MA) in separate email sent at the same time as Sanders’ announcement Wednesday.

“Republicans leaders are trying to dress up a massive tax break for billionaires and giant corporations as ‘tax reform,’” wrote Warren, a co-sponsor of Sanders bill. “And they want to pay for it by gutting Social Security, Medicare, Medicaid, public education, and other critical services for working families. This feels like the health care fight all over again. We can’t let our guard down—even for a minute.”

So while Sanders is urging progressives and Americans to take the high road on health care, Warren is warning progressives and Americans about the GOP’s path on the low road: to destroy today’s safety nets, not improve or expand them. Indeed, even the latest bipartisan Senate effort to stabilize Obamacare premiums for 2018 saw Health Education Labor and Pensions (HELP) Committee Chairman, Sen. Lamar Alexander (R-TN) propose reeling in coverage requirements and allowing premium increases.

While Alexander's HELP Commitee is meeting, another GOP bill repealing Obamacare and gutting Medicaid was being promoted in Washington on Tuesday. The proposal, from Sens. Cassady, Heller and Graham, would cause an estimated 30 million people to lose coverage in a decade, stop Obamacare's Medicaid expansion, redistribute Obamacare funds from blue states to red states, convert Medicaid into per-capita block grants and end federal support for reproductive healthcare related to family planning.

Against this backdrop comes Sanders’ call for a political revolution that includes a national single-payer system—his version of Medicare for All. In the short run, Sanders’ bill may help Democrats push back against industry allies like Alexander. But in the long run, he’s saying an entirely new breed of elected officials is needed in Washington, and Medicare for All is a key standard by which candidates can be gauged in 2018 and after.