Update: On Mon­day, July 17, the Repub­li­can health­care plan in the Sen­ate was effec­tive­ly killed when enough GOP sen­a­tors announced their oppo­si­tion to the bill to ensure it would not pass, caus­ing Major­i­ty Leader Mitch McConnell to pull the bill from con­sid­er­a­tion.

Making single-payer a demand can provide a clear message of where politicians stand—and call out the hypocrisy of Trump, who as a candidate promised “insurance for everybody.”

The fail­ure of Trump­care to pass the House on Fri­day was a dev­as­tat­ing defeat for both the nascent admin­is­tra­tion and the GOP. For sev­en years, Repub­li­cans railed against Oba­macare, promis­ing to ​“repeal and replace” the law as soon as they could. Trump him­self pledged to do so repeat­ed­ly on the cam­paign trail and from the Oval Office.

Yet despite con­trol­ling both hous­es of Con­gress and the pres­i­den­cy, Repub­li­cans could not get a bill through their own cau­cus in the House. Speak­er Paul Ryan, one of the bill’s archi­tects, admit­ted, ​“This was a dis­ap­point­ing day for us.”

Democ­rats under­stand­ably respond­ed with glee. How­ev­er, besides Bernie Sanders, their side of the aisle offered lit­tle in the way of a counter pro­pos­al for how to address the very real prob­lems with Obamacare.

Trump and Ryan cor­rect­ly pre­dict that the issues with the cur­rent health­care sys­tem — from ris­ing pre­mi­ums to insur­ers pulling out of exchanges — are only going to get worse over the com­ing months and years.

Part of the rea­son is that Repub­li­cans will do every­thing in their pow­er to make sure these prob­lems inten­si­fy. Health Sec­re­tary Tom Price, a long­time oppo­nent of Oba­macare, has con­sid­er­able lever­age to dis­rupt the already frag­ile sys­tem set up by the Afford­able Care Act.

But the fun­da­men­tal fail­ures of Oba­macare stem from the law’s reliance on the pri­vate mar­ket. Why are insur­ance com­pa­nies such as Humana and Aet­na flee­ing the exchanges? Why are pre­mi­ums spik­ing for many mid­dle-class Amer­i­cans? Because pri­vate com­pa­nies are respond­ing to the log­ic of cap­i­tal: Max­i­mize prof­its while reduc­ing costs.

When Repub­li­can gov­er­nors reject Med­ic­aid expan­sion, more sick, low-come peo­ple require insur­ance cov­er­age — the health­care con­sumers who are the most expen­sive to treat. This, in turn, cre­ates a dis­in­cen­tive for insur­ers to offer afford­able plans through the exchanges, and, as a con­se­quence, providers pull out of mar­kets and costs rise for everyone.

This trend is sure to con­tin­ue if noth­ing is done to fix the sys­tem, and the only fix that will work is to expand the risk pool and include every­one. With such a sys­tem of uni­ver­sal cov­er­age, costs would be spread out even­ly and ill­ness would no longer be seen as a lia­bil­i­ty in deter­min­ing the costs and ben­e­fits of care.

Any real long-term solu­tion must take this ques­tion of the mar­ket head on by mov­ing to elim­i­nate the pri­vate health­care insur­ance industry.

The real alternative

So how can Democ­rats respond to the prob­lems with Oba­macare and the com­ing sab­o­tage? The answer is sim­ple, and incred­i­bly pop­u­lar: Push for a sin­gle-pay­er, Medicare-for-all system.

Bernie Sanders, the most pop­u­lar politi­cian in Amer­i­ca and open demo­c­ra­t­ic social­ist, plans to intro­duce leg­is­la­tion cre­at­ing a Medicare-for-all sys­tem in the Sen­ate in the com­ing weeks. Demo­c­ra­t­ic Nation­al Com­mit­tee Deputy Chair Kei­th Elli­son, a co-spon­sor of a Medicare-for-all bill in the House, has reit­er­at­ed his sup­port for the mea­sure. And as Dave Weigel reports at the Wash­ing­ton Post, more Democ­rats are com­ing around to the idea. Even Nan­cy Pelosi, who recent­ly said of Democ­rats, ​“We’re cap­i­tal­ists, and that’s just the way it is,” is voic­ing sup­port for single-payer.

A sin­gle-pay­er plan would mean the Unit­ed States would final­ly join the rest of the devel­oped world in guar­an­tee­ing health­care to all cit­i­zens regard­less of their income. And it would great­ly reduce costs.

Plus, as Medicare for All orga­niz­er and long­time pris­on­er jus­tice advo­cate Mari­ame Kaba recent­ly explained, it direct­ly speaks to the needs of work­ing peo­ple by build­ing off of an already incred­i­bly pop­u­lar program:

What you need in an orga­niz­ing sense is you need an issue to be able to appeal to peo­ple. Medicare is what we have that is the most close to a kind of social­ist pol­i­cy in place around health­care. It’s the one that peo­ple under­stand, that they already have…You orga­nize around the things that have mate­r­i­al, direct, and urgent impact on people’s lives, and then you push those peo­ple through that fight into fight­ing for oth­er things together.

The bar­ri­ers to pass­ing sin­gle-pay­er in the cur­rent polit­i­cal ter­rain are sig­nif­i­cant. Repub­li­cans want to move in pre­cise­ly the oppo­site direc­tion, sep­a­rat­ing gov­ern­ment from health­care. And mod­er­ate and con­ser­v­a­tive Democ­rats have his­tor­i­cal­ly been resis­tant to such a plan.

But fol­low­ing the spec­tac­u­lar fail­ure of the Repub­li­can bill, momen­tum is on the side of the oppo­si­tion. This cre­ates an oppor­tu­ni­ty that pro­gres­sive groups are hop­ing to seize.

Orga­ni­za­tions such as Nation­al Nurs­es Unit­ed, the Work­ing Fam­i­lies Par­ty, the Demo­c­ra­t­ic Social­ists of Amer­i­ca and the Pro­gres­sive Cam­paign Change Com­mit­tee all hope to orga­nize the grass­roots in order to take advan­tage of this new­found push for single-payer.

From demand to reality

Much report­ing on the GOP fail­ure to pass Trump­care has focused on Repub­li­can infight­ing, but the mas­sive out­pour­ing of resis­tance from the pub­lic played a crit­i­cal role. Phone calls from con­stituents went 50 – 1 against the bill, and recent con­gres­sion­al town halls have been mir­ror images of those crashed by Tea Par­ty pro­test­ers dur­ing the fight over Obamacare.

A con­tin­u­a­tion of this cit­i­zen engage­ment will be need­ed to move the coun­try clos­er to a sin­gle-pay­er sys­tem. In states such as Rhode Island and Cal­i­for­nia, local activists are push­ing pro­pos­als for sin­gle-pay­er. And while the bills sup­port­ed by Sanders and Elli­son are unlike­ly to pass now, they pro­vide Democ­rats with a ral­ly­ing point to demand a tru­ly uni­ver­sal health­care sys­tem — a propo­si­tion sup­port­ed by 58 per­cent of Americans.

This would also open the door to pro­pos­als that lay the foun­da­tion for sin­gle-pay­er, whether it’s allow­ing the import of cheap phar­ma­ceu­ti­cals from Cana­da and oth­er coun­tries, intro­duc­ing a pub­lic option on the exchanges or low­er­ing the Medicare age to 55 — a pop­u­lar idea that near­ly became law with the pas­sage of Oba­macare before it was tor­pe­doed by then-Sen. Joe Lieber­man. Low­er­ing the Medicare age would clear the path for even­tu­al­ly tak­ing it all the way to zero.

The crash­ing and burn­ing of Trump­care will ben­e­fit mil­lions of Amer­i­cans. Yet mil­lions con­tin­ue to live with­out afford­able health­care. Mak­ing sin­gle-pay­er a demand pro­vides a clear mes­sage to politi­cians: Where do you stand? It also pro­vides an oppor­tu­ni­ty to call out the hypocrisy of Trump, who as a can­di­date promised ​“insur­ance for everybody.”

Sin­gle-pay­er would do that, and it would cost con­sid­er­ably less than the cur­rent sys­tem. That is a clear and sim­ple mes­sage, and it’s a win­ning one for 2018 and beyond.