The grass­roots fight for sin­gle pay­er, cham­pi­oned by Bernie Sanders, has thor­ough­ly reframed the health­care debate over the past year.

It’s impossible to talk about universal coverage without talking about the power and corrupting influence of corporations.

That became clear dur­ing CNN​’s Mon­day night health­care debate between Sens. Lind­sey Gra­ham (R‑S.C.), Bill Cas­sidy (R‑La.), Bernie Sanders (I‑Vt.) and Amy Klobuchar (D‑Minn.). The debate came as Repub­li­cans labor, Sisy­phus-like, to ​“repeal and replace” the Afford­able Care Act (ACA). Gra­ham said in his open­ing remarks that the debate was about ​“who we want to be as a nation.” Cas­sidy said that it was about who has power.

Sanders, who duti­ful­ly defend­ed the ACA on Mon­day but made it clear that his ulti­mate goal is a sin­gle-pay­er sys­tem, agrees with Gra­ham and Cas­sidy that the health­care debate isn’t real­ly about health­care. As he said to a Vox inter­view­er recent­ly, ​“what this strug­gle is about real­ly, hon­est­ly, is not a health­care debate.”

What is it about then? Well, it’s about pow­er. And it’s about who we want to be as a nation. Just like Gra­ham and Cas­sidy said. In oth­er words, the health­care debate cen­ters around the big-pic­ture ques­tions of our moral respon­si­bil­i­ties to one anoth­er — and our dis­tri­b­u­tion of resources with­in U.S. society.

It’s impos­si­ble to talk about sin­gle pay­er with­out talk­ing about the inequal­i­ties of the cur­rent sys­tem, and the fact that 28 mil­lion peo­ple are still unin­sured. Sanders does that all the time. He did so again Mon­day. But so did Gra­ham and Cas­sidy. The Repub­li­cans’ point was just that the ACA’s fail­ures had priced too many peo­ple out of the mar­ket, and state-based pro­grams are a bet­ter path to tru­ly uni­ver­sal coverage.

It’s impos­si­ble to talk about uni­ver­sal cov­er­age with­out talk­ing about the pow­er and cor­rupt­ing influ­ence of cor­po­ra­tions. Such talk is expect­ed from Sanders. But it was a Repub­li­can, Gra­ham, who said Mon­day that ​“the biggest win­ner under Oba­macare is insur­ance com­pa­nies, not patients.” It was Cas­sidy who said that the ACA is a huge give­away to the phar­ma­ceu­ti­cal com­pa­nies, the hos­pi­tal sec­tor, the health insur­ance indus­try — every­one but the Amer­i­can people.

Whether they actu­al­ly believe these things doesn’t mat­ter. What mat­ters is that Repub­li­cans were talk­ing about health­care using a pro­gres­sive frame­work that focus­es on pow­er and inequal­i­ty. This moment, in some ways, is an inverse of what we saw in the 1980s, dur­ing the ear­ly stages of the neolib­er­al ascen­dan­cy, when Ronald Rea­gan and the GOP framed their push for tax cuts and dereg­u­la­tion as a mat­ter of indi­vid­ual ​“free­dom.” That fram­ing still per­vades our polit­i­cal dis­course. You might whol­ly reject the neolib­er­al notion of free­dom. But you can’t escape it.

That’s what sin­gle pay­er is doing for the pro­gres­sive move­ment, for some ele­ments of the Demo­c­ra­t­ic Par­ty, and for our polit­i­cal dis­course gen­er­al­ly. As with the GOP’s push for tax cuts, the pro­gres­sive health­care push forces peo­ple across the polit­i­cal spec­trum to engage ques­tions about ​“who we want to be as a nation.” It puts pow­er and inequal­i­ty front and cen­ter in a way that few oth­er issues have the pow­er to do. It reframes the debate.

Ear­li­er this month, Sanders intro­duced a ​“Medicare-for-all” bill in the Sen­ate. It has sub­se­quent­ly gained sup­port from at least 21 Demo­c­ra­t­ic sen­a­tors, includ­ing sev­er­al of the party’s poten­tial pres­i­den­tial con­tenders in 2020, like Sen. Kamala Har­ris, of Cal­i­for­nia, and Sen. Kirsten Gilli­brand, of New York. A sim­i­lar sin­gle-pay­er bill in the House has 119 sup­port­ers. Nei­ther bill has any chance of imme­di­ate suc­cess, in strict­ly leg­isla­tive terms.

In broad­ly polit­i­cal terms, how­ev­er, the slow-build­ing wave of sup­port for these bills has the poten­tial to be momen­tous. Trans­for­ma­tive phi­los­o­phy needs the engine of actu­al pol­i­cy. Sin­gle pay­er, like the Right’s obses­sion with tax cut­ting and dereg­u­lat­ing, is both a vision of how things should be and a plan to get there.

“This fight,” Gra­ham said on Mon­day, ​“it’s just begin­ning.” He meant the fight to repeal and replace the ACA specif­i­cal­ly. But the evi­dence from Mon­day evening sug­gests that there is a big­ger fight brew­ing, with terms set by left and pro­gres­sive forces. And it may well be more than Gra­ham, Cas­sidy, and the GOP had bar­gained for.