When Sen. Bernard Sanders reintroduced his “Medicare for All” bill in the Senate in April, four of his fellow Democratic presidential hopefuls signed on with him, thrilling liberal activists who believed the universal health care proposal was becoming unstoppable.

Four months later, Mr. Sanders is looking more and more like a lonely holdout after watching his allies slink away as politics of the plan shift.

The guy who “wrote the damn bill” says it is the answer to the nation’s troubled health insurance system, but that is an increasingly tough sell to voters in early primary states who say they don’t want the government messing with their private insurance.

“The candidates got way over the front of their skis on this one,” said Robert Laszewski, a health care policy consultant in Virginia. “That is where the left-wing echo chamber is. That is not where the country is. What is remarkable is how many Democrats got trapped into that and are now having to reel that back.”

The reel-back has played out over the course of two Democratic presidential debates, with the likes of Sen. Kamala D. Harris — who is still listed as a sponsor of Mr. Sanders‘ bill — arguing why it’s not workable.

On at least three occasions, the California Democrat has had to clarify that she doesn’t support abolishing private health insurance, even though that’s what Mr. Sanders says his plan would essentially do after a four-year transition period.

Ms. Harris is now offering a competing plan that steals Mr. Sanders‘ “Medicare for All” moniker but says she will keep private insurance intact. Some liberals say they are willing to listen to her sales pitch but that the advertising is false.

Things got awkward for Ms. Harris this week in Iowa when a woman in a nursing home grilled her over who would pay for her health care plan and warned her to “leave our health care system alone.”

“We don’t want you to mess with it,” the white-haired resident snapped in an exchange that was captured on video and widely circulated on social media.

Those sentiments are shared by most Iowa Democratic caucusgoers. A recent Monmouth University Poll shows that 56% prefer keeping private coverage and adding a public option to Obamacare, and 21% want to scrap the system and replace it with Medicare for All.

But liberal activists who are providing much of the energy in the Democratic Party say they want the candidates to go as far as they can in upsetting the system.

“What this debate is exposing in very clear terms is which candidates are prepared to take on the special interests that have been fighting the idea that health care is a human right for the past 70 years and who isn’t,” said Neil Sroka, of Democracy for America.

“It shows who is going to push for a big idea whose time has long past come and who, as we have seen for decades, will shrink in the face of opposition,” he said.

Mr. Sanders has long been an advocate for a single-payer health care system — one that lets the government run the market. His breakthrough came when he coupled that idea with Medicare, which for five decades has been the basic health care program for seniors, allowing them to choose doctors and having Uncle Sam pick up most of the tab.

Under Mr. Sanders‘ plan, the government would cover all U.S. residents, including illegal immigrants. It would pay for doctor and hospital visits, prescription drugs, dental and vision services, and long-term care. Private insurance would be allowed, but only as a supplement. The government would have a monopoly on basic health care coverage.

Mr. Sanders says his vision would save money and produce better health care results for most Americans.

Analysts debate whether he is right.

California pondered attempting a single-payer system in recent years but backed away after seeing the price tag of $350 billion to $500 billion a year, about double the state’s budget.

“The price tag is astronomical,” said David McCuan, a political science professor at Sonoma State University. “Most Democratic politicians are sobering up to the fact that incrementalism is the way to go. That doesn’t excite activists and doesn’t turn out the base … but they are not moderates that constitute the majority of voters in Iowa, New Hampshire or even South Carolina or Nevada.”

The Committee for a Responsible Federal Budget says Mr. Sanders‘ plan at the national level would cost as much as $32 trillion over the next decade, more than double what Mr. Sanders claims.

Yet for the presidential candidates, it’s not the cost as much as the health care outcomes that are scaring Mr. Sanders‘ opponents.

While signing onto Mr. Sanders‘ bill, Sen. Cory A. Booker of New Jersey says what he really wants is the public option. Likewise, Sen. Kirsten Gillibrand of New York.

Rep. Tulsi Gabbard of Hawaii, another 2020 presidential hopeful, has co-sponsored the House version of Medicare for All. But she has distanced herself from Mr. Sanders‘ vision over the past week, saying there must be a role for private coverage.

“Private insurance, if you want to choose that route and go for a private option, that is up to you,” she said.

Meanwhile, Sen. Elizabeth Warren, who also is a co-sponsor of Mr. Sanders‘ bill, now labels Medicare for All a “goal.”

Jeff Weaver, a senior Sanders adviser, said if Ms. Warren is relegating Medicare for All to an aspiration rather than a concrete policy, then “that is not the same as what Bernie Sanders is talking about.”

“Because of the popularity of Medicare for All, I think a lot of candidates were attracted to the branding of Medicare for All but are unwilling to do what is necessary to provide health insurance for people at a price they can afford,” he said. “That includes taking on the insurance companies.”

The Warren campaign did not return an email seeking clarification.

Yet to be seen is just how popular the idea is outside of the far left wing of the Democratic Party.

Polls show voters support the idea until they learn they will likely lose their current health insurance and could pay more in taxes.

Mr. Sanders, though, has had no second thoughts and still proudly sells “Medicare for All” T-shirts, buttons and coffee mugs on his campaign website.

He tells voters he is confident they will accept the higher taxes because their out-of-pocket health care costs will drop by even more, and he says they will like their health care better once it’s not controlled by for-profit corporations.

“The function of the current health care system is not to provide quality care to all; it is to make tens of billions of dollars in profit for the drug companies and the insurance companies,” Mr. Sanders said in a recent interview on “The Joe Rogan Experience” podcast.

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