Fresh on the heels of a dustup over single-payer health care, a new fight between the Hillary Clinton and Bernie Sanders campaigns is exposing some deep-seated rifts between the two camps. This time the fight is over how the candidates handle identity politics and who is part of the "establishment" that needs to be challenged.

Rachel Maddow asked Sanders Tuesday night about Hillary Clinton's recent endorsements from the Human Rights Campaign, which advocates for LGBTQ rights, and from Planned Parenthood, which is endorsing a presidential candidate for the first time. "Are you competing for those groups’ endorsements and not getting them?" Maddow asked. "Or are you not trying to get those groups' endorsements?"

Sanders responded that he's proud to have been endorsed by groups like MoveOn and Democracy for America. Then he added that his campaign is "taking on the political establishment," which includes groups like Planned Parenthood and the Human Rights Campaign:

We're taking on not only Wall Street and the economic establishment, we're taking on the political establishment. So, I have friends and supporters in the Human Rights Fund [sic], in Planned Parenthood. But you know what, Hillary Clinton has been around there for a very, very long time, and some of these groups are in fact part of the establishment. I will challenge anybody with regard to my record on LGBT issues. I was one of the few, relatively few, to oppose and vote against DOMA [Defense of Marriage Act], et cetera. In terms of women's rights, I believe we have a 100 percent lifetime pro-choice record.

Clinton, and the groups in question, took those remarks as an insult.

Really Senator Sanders? How can you say that groups like @PPact and @HRC are part of the "establishment" you're taking on? -H — Hillary Clinton (@HillaryClinton) January 20, 2016

We respect @SenSanders. Disappointed to be called "establishment" as we fight like hell to protect women's health. https://t.co/kiimTsVw2x — Planned Parenthood (@PPact) January 20, 2016

We share @PPact's disappointment in Sanders' attacks. @HRC has proudly taken on the establishment & fought for LGBT people for over 30 years — HumanRightsCampaign (@HRC) January 20, 2016

Why advocates are upset about the "establishment" comments

The word "establishment" gets thrown around a lot, and it's not always clear what it means. But especially when it comes to Sanders, "establishment" can feel like a dirty word. It's the people who fight for the status quo for those in power, and against the interests of ordinary people who can't catch a break.

From that perspective, it seems strange at best and insulting at worst to dismiss advocates who have been fighting for the rights of marginalized groups — LGBTQ people who want to get married, or low-income women who need access to affordable reproductive health care — as "establishment." And the idea that Sanders actually wants to "take on" the advocates for these causes is pretty jarring.

Planned Parenthood executive vice president Dawn Laguens said in a statement that she was "disappointed" that Sanders would say this. "This country sees attacks against reproductive health, reproductive rights, and marriage equality every day — especially from every single GOP candidate for President," Laguens said. "Reproductive health care and rights, and the full equality of LGBTQ people, are core progressive values that should unite us all."

The Planned Parenthood comments in particular seem tone-deaf and shortsighted to many advocates. While Planned Parenthood does have some influence among Democrats, it's also a health care provider under siege — sometimes literally, as when a horrifying attack in Colorado Springs by a gunman who opposes abortion left three people dead. The organization faces constant defunding attempts at both the federal and state level, constant protests that make patients and providers feel unsafe, and 15 years' worth of dubious campaigns by anti-abortion activists to publicly discredit the group.

That's why some progressives think it's unfair to lump the Human Rights Campaign and Planned Parenthood together:

We can separate PP and HRC. PP is a critical provider of health care fighting for its life. HRC is a milquetoast org that avoids big fights. — Jesse Berney (@jesseberney) January 20, 2016

Why Sanders said what he did

Sanders and his supporters have been frustrated by the lack of endorsements from big progressive and Democratic organizations — especially the Democratic National Committee, which has basically scheduled the Democratic primary debates into obscurity. It might have felt like a particular betrayal when the major labor union SEIU endorsed Hillary Clinton, given that Sanders has been on the front lines of that group's "Fight for 15" campaign to raise the minimum wage to $15 an hour.

Sanders supporters suggest that when groups like DFA and MoveOn actually poll their members and take their cue from the grassroots, Sanders wins — but when big nonprofits or labor unions make top-down decisions, Clinton wins.

Sanders's comments to Maddow were animated by this populist sentiment. He went on to talk about how he thinks his campaign is going to win, but not because of support from big groups. It's going to be a groundswell of grassroots support and enthusiasm — a political revolution, as he's often fond of saying.

It's hard to deny that both Planned Parenthood and the Human Rights Campaign have some well-established influence in the Democratic Party. They both have Super PACs and throw galas featuring Democratic lawmakers, and Democrats often take messaging cues from them on women's or LGBTQ rights. When he said "establishment," Sanders pretty clearly meant "the Democratic establishment."

And it's not just Sanders supporters who would argue that the groups are "establishment." The Human Rights Campaign has been criticized by LGBTQ rights activists for its diversity problems, its late entry into the marriage equality fight, and its praise of groups like Goldman Sachs. Planned Parenthood has also faced critiques from reproductive justice advocates who say the organization hasn't done enough to acknowledge the role of women of color in the movement, or to challenge Democrats who make political concessions on reproductive rights.

Planned Parenthood had legitimate ideological reasons to endorse Clinton

It's understandable if Sanders is annoyed that the Human Rights Campaign endorsed Clinton over him. Both candidates support marriage equality, but Clinton took four years longer to do so. Clinton also used to endorse the Defense of Marriage Act, while Sanders didn't. (To be clear, both campaigns are engaged in some historical revisionism on DOMA.)

But it's harder to argue that Sanders has a legitimate beef on Planned Parenthood. The organization laid out some pretty specific reasons why it's endorsing Hillary over Bernie. Both candidates do indeed have spotless pro-choice voting records, but Clinton has been much more proactive on reproductive health and women's rights issues. Sanders co-sponsors and votes for the right bills, but Clinton introduces legislation and wages active campaigns.

Planned Parenthood also objects to the idea that its endorsement came from some kind of top-down cabal in the DNC's pocket. A spokesperson for the organization told Vox that the endorsement process included a big-tent panel with Planned Parenthood staff, a patient, a provider, and grassroots volunteers, and that the decision happens in conjunction with conversations with affiliates around the country.

It's also worth noting that Clinton recently advocated for repealing the Hyde Amendment, which restricts federal funds for abortion — an issue that even Planned Parenthood has only recently gotten more outspoken on thanks to new grassroots pressure. Meanwhile, Sanders released a Medicare-for-all plan without acknowledging that as long as Hyde is law, Medicare can't fund abortion coverage.

This fight speaks to other issues the Sanders campaign has had with identity politics

Whenever Sanders is criticized on an identity issue like race or gender, he and his supporters are quick to defend him by pointing to his record. He's always voted the "right way," he marched with Martin Luther King, etc.

But arguments like that ring hollow to some progressives. Witness the Black Lives Matter movement, which has pushed Sanders to speak out more about racial justice. For these activists, it wasn't enough for Sanders to have the right voting record or policy positions. He had to talk about racial justice, a lot, with a comprehensive analysis of why police violence happens and how to fix it. He had to show that he would actively prioritize these issues and work to fix them, not just passively support them if they happened to come up.

Sanders has changed his tune on racial justice significantly since those protests, but he still stumbles occasionally. Ta-Nehisi Coates took Sanders to task for dismissing reparations as politically infeasible when none of his economic justice proposals could make it through the current Congress either. And in an awkward moment during the last Democratic debate, Sanders seemed to mentally separate blacks and Latinos from the "general population":

I think blacks & Latinos, for Dems, now *are* the "general population"—but IDK ¯\_(ツ)_/¯ https://t.co/wI5Z1rKMUy pic.twitter.com/a3nC2W35Gy — Greg Greene (@ggreeneva) January 18, 2016

The pushback against Sanders from some reproductive justice activists is similar to the pushback from Black Lives Matter and other racial justice activists. In the current political climate, with its unprecedented wave of anti-abortion lawmaking, advocates say that fighting for reproductive rights is about more than having the right policy positions or voting the right way.

Sanders has a strong voting record on race and gender justice issues, and he's shown a willingness to listen to criticism and adapt. He also has a point about how the Democratic "establishment" has favored Clinton from the beginning. But gaffes like these reveal that he thinks identity issues are unimportant when compared with class struggle, and indeed that they get in the way of it. That could be a problem if he wants to keep expanding his nonwhite-male voter base.