US Senator Elizabeth Warren (C) speaks with US Senator Bernie Sanders (2nd R) as they discuss Medicare for All legislation on Capitol Hill in Washington, DC, on September 13, 2017. (Photo: Jim Watson / AFP / Getty Images)

Last month, Bernie Sanders unveiled a Senate bill that would phase in government-run universal health care. The single-payer, Medicare-for-all proposal attracted over a dozen Democratic Party co-sponsors and ignited progressives’ hopes across the country.

Liberal figures like Sen. Elizabeth Warren of Massachusetts signed on, but so too did other likely contenders for the 2020 presidential nomination — Sen. Cory Booker of New Jersey, Sen. Kirsten Gillibrand of New York, and Sen. Kamala Harris of California.

In the House, Rep. John Conyers (D-Mich.) has again put forward his Medicare-for-all bill, as he has every year since 2003. But this year, his proposal has attracted over seventy Democratic Party co-sponsors.

As an added bit of good news for proponents, a recent Kaiser Family Foundation poll reported that single payer enjoys majority support for the first time ever. Many commentators believe single payer is finally having its moment.

It’s easy to see why government-run health care is so popular today. Even under Obamacare and before the Republican repeal effort, the status quo is horrifying.

Alongside Sanders’s announcement, thousands of people flooded a yearly, one-day-only free medical clinic at a fairground in Wise, Virginia. Many are trapped in the chasm of health coverage. They can’t afford private insurance but are over the poverty line for Medicaid.

Matt Sutherland, one among the desperate thousands, walked over 30 miles to last year’s clinic just to get a chance at the care he needs. He didn’t have a car, so he had to endure a seven-hour journey to the fairgrounds by foot.

As the opioid epidemic rips through Rust Belt cities like Cincinnati, people brought back from death’s edge by naloxone often refuse ambulance trips to the hospital. Though 3,500 people are brought to American hospitals every day because of opioids, those stats may still undersell the crisis as people skip medical care. Kentucky and Ohio have some of the highest death rates in the nation from opioid overdoses, but they don’t even crack the top ten when it comes to rates of opioid hospitalizations. When a two-mile ambulance ride can cost as much as $2,700, it’s easy to see why.

Sexism and racism affect our health-care system just like the rest of society. As Reuters reported in April, US women with private insurance have to pay on average $950 in out-of-pocket medical expenses after enduring the horror of sexual assault.

These are just some of the indignities forced on people as they try to stay alive in the richest country in the world. These are also the realities driving people’s hunger for an alternative.

Sanders deserves credit for bringing Medicare-for-all into popular parlance. His 2016 campaign kicked up sentiments that had been building for years, born from the growing wealth gap since the seventies, the economic crash of 2007, Occupy’s camp on Wall Street and Missouri marches for Black lives.

The outpouring of support he received came out these lived realities and flashes of struggle. The groundswell for single payer preceded Sanders, in documentaries, pickets and protests in the mid-2000s. Still, his campaign helped reveal just how many people were ready to raise their political horizons.

Despite Trump’s flurry of attacks in the past year, those horizons haven’t lowered. If Sanders has put single payer in people’s sightlines, can his Senate bill actually make it a reality?

He faces serious opposition and he knows it. Unsurprisingly, Republicans lambasted Sanders’ proposal as pie-in-the-sky. They bandy about false arithmetic and scary numbers, like a supposed $32 trillion bill to taxpayers over ten years. They imagine a health-care hellscape of long lines and poor care.

Of course, our current health-care system will likely cost us $49 trillion over the same period. And anyone visiting an emergency room in the United States can expect long lines as well. Yet Republicans argue single payer is socialistic and unrealistic.

Most Democratic Party leaders stand against it too. Even before Hillary Clinton was touring the country to drum up book sales and comparing Sanders’s political revolution to demanding free ponies, she made her anemic position clear during the campaign: “Single payer will never, ever happen.”

Democratic Party politicians from Colorado to California have made sure of that, blocking single payer at the state level. Congressional Democratic leaders like Chuck Schumer and Nancy Pelosi have so far declined to endorse Sanders’ or Conyers’ plan. Even the liberal press, columnists like Doyle McManus of the Los Angeles Times and the Washington Post editorial board, have come out against Sanders.

Members of Congress from both parties oppose “reckless spending” but have had no problem giving President Trump tens of billions more dollars in war funding. A simple reply can be given to the naysayers. Single payer won’t bankrupt America because private health care is already doing it.

But beyond the expected attacks from liberal “realists” and right-wing reactionaries, even supporters of the bill have low expectations for its future.

Sen. Al Franken (D-Minn) described the bill as “aspirational”. “In the short term, however, I strongly believe we must pursue bipartisan policies that improve our current health-care system,” he wrote in a recent Facebook post.

Sen. Tammy Baldwin (D-Wis.) has co-sponsored the bill but has also endorsed other health-care bills that would invalidate Sanders’. Her name is attached to competing pieces of legislation that would phase in Medicare for all, lower the Medicare age to 55 and allow people to buy into Medicaid — all at the same time.

Sanders himself admitted to the Atlantic that single payer likely won’t be part of the Congressional Democrats’ party platform: “I would like it to be in it, do I think it will be in it? Probably not. I think it’s too radical [in the view of Democratic leadership] at this moment,” he said.

Then what is his bill for? Sanders can hold up the support Medicare for all has received from some corners of the Democratic Party as a sign changing the party from within is possible. On the other hand, the bill allows some Democrats to say on record, and strictly in rhetoric, that they support a left-wing issue. In looking to 2018 midterm and 2020 Presidential elections, Democrats need media moments like these to excite their base — especially since their party is even less popular than Trump.

Columnist Paul Waldman said as much in the Washington Post. “It doesn’t have to be realistic … this bill could be extremely useful since it will communicate the Democratic vision to voters in a way that isn’t too hard to understand,” he writes. “Democrats can posit this plan as what they’d like in a perfect world — but also say that they’d accept a more practical, incrementalist path that would eventually achieve many of the same goals.”

The implied argument is simple: if people want single payer, then they better get out to vote in 2018. But Democrats are ultimately under no obligation to fulfill their end of the bargain.

Cory Booker gave a similar pitch in a January meeting with activists who were angry that he opposed importing cheaper prescription drugs from Canada. Just after joining a dozen other Democrats to stop a bill to improve health care for ordinary people, Booker had the gall to say Democrats couldn’t improve health care so long as Republicans control Congress.

“The Republicans control the Senate and that is really important to understand,” he said in a recording of the closed-door meeting. “No matter what, the chances of a bill getting to the floor without 51, without 50 Senate Democrats is very very hard on this issue.”

If Booker believes the Democrats can’t even lower the cost of prescription drugs in the current Congress and opposed that minor reform, no less, then is he really joining Sanders to radically reshape the health-care system?

It’s tough to argue Medicare for all is even a long-term goal for someone like Booker. The supposed single-payer supporter received the third most insurance industry contributions in the 2014 senatorial election cycle. This is the very industry single payer would eliminate. And unlike his donations from pharmaceutical companies, which he has pledged to put a “pause” on, Booker hasn’t promised to put the hundreds of thousands of dollars he raises from the insurance sector on hold.

Yet the problem goes deeper than individual Democrats and where they fill their coffers. Both parties are committed to cutting the costs of health care for corporations. As a result, they have pushed those health-care costs onto workers. As Elizabeth Fowler, an architect of the Affordable Care Act — Obamacare — and now an executive for Johnson and Johnson said of law she helped write,”Everybody is focused on the coverage angle, but the changes in the law designed to address cost could be a bigger and longer-lasting change.”

Even though Obamacare added important protections for patients, it also cut Medicare by $716 billion over ten years. Likewise, earlier versions of Trumpcare would have cut Medicaid by $772 to $834 billion over a similar period.

Far from expanding government-run health care, both parties are trying to cut it as much as they can — even as they weigh the interests of some sections of the health-care industry that depend on those programs for their profits.

Two months ago, Democrats attacked Sen. Steve Daines (R-Mont.) for trying to attach a dead-letter single-payer plan as an amendment to Trumpcare. Back then Democrats put a minus sign next to such political games; today they put a plus.

This isn’t a new trick. Democrats have used other issues to entice ordinary people to get out the vote. Immigrant rights serve as perhaps their most glaring post-election betrayal in recent memory.

In a July 2008 speech to the League of United Latin American Citizens, then-candidate Barack Obama declared. “We need a president who is not going to walk away from something as important as comprehensive immigration reform when it becomes politically unpopular.” He promised to make it a “top priority” in his first term, but only if people voted for his ticket.

“During the immigration marches back in 2006, we had a saying — today we march, tomorrow we vote,” he said. “Well, that was the time to march. Now comes the time to vote.”

Buoyed by his rhetoric, Latinos delivered President Obama the votes he asked. According to the Pew Hispanic Center, the Obama-Biden ticket beat McCain-Palin’s among Latinos by a two-to-one margin. Just four years after George W. Bush won 57 percent of Latino votes in Florida, Obama carried that state demographic by 56 percent.

Once in office, Obama didn’t just avoid introducing an immigration reform bill in his first year, as he had promised journalist Jorge Ramos. He ran a deportation machine more brutal than any that came before him. Over 2.5 million people were deported during his two terms in office, a figure greater than the total number of people deported over the 20th Century and 25 percent more than were deported by Bush.

Like Trump today, he deported families as well as felons. The Dream Act languished for his first four years. As late as 2016, his administration was arguing children as young as three years old didn’t need lawyers and could represent themselves in deportation proceedings. Seriously.

Obama’s brutally cold feet on immigration only began to warm from struggles waged by ordinary people, far from the halls of Congress.

To force Obama’s feet forward, undocumented Dreamer activists held sit-ins at his campaign offices in 2012. After years of stalling, Obama issued an executive order creating Deferred Action for Childhood Arrivals (DACA) within days of the protests. Even still, he remained the “Deporter-in-Chief” to many.

Today, the Democrats are still trying to make sense of what happened and chart a path into 2018 and 2020. With fewer people believing their party’s promises than ever, the Democratic Party has a solution: make bigger promises. Democrats like Kamala Harris are seeking to channel Americans’ left-wing sentiments into the ballot box. As ever, the establishment wing of the Democrats will work to lower expectations and corral ordinary people’s demands into channels that are safe for the profit system.

This division does not represent a fundamental split in the Democrats, but a reflection of the regular division of labor within the party since the 1980s. The progressive wing pitches the party as representative of working and oppressed people. The establishment wing dictates policy and uses pragmatism as a bludgeon against people’s hopes and demands.

A sustained grassroots movement could force the issue of single payer, as immigrant activists did with DACA. Sanders’s bill provides an opening for real progressives and advocates for a humane health-care system to push forward. With Democrats giving rhetorical support for single payer, more people may be willing to fight for it. As advocates for socialized medicine join hands with liberals to fight for single payer, they will have an added political task: to patiently expose the Democrats as a party of talk, not action; a party that will adopt their demands to garner votes but has no problem betraying them once in power — unless pressure is maintained.

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