House Democrats kicked off a hearing on single-payer health care by downplaying Obamacare as an initial stop on the road to universal coverage, saying millions of Americans remain uninsured and a scary diagnosis can still mean bankruptcy.

“That is what today is all about, because the work of reform isn’t done,” said Rep. James McGovern, Massachusetts Democrat and House Rules Committee chairman, before hearing from witnesses on both sides of the debate over “Medicare for All.”

Testimony from Ady Barkan, an advocate who is dying from ALS and used a computer to testify aloud, loomed over the hearing. He said it’s time to end the profit-driven health system and usher in “a comprehensive social safety net that actually catches us when we fall.”

He said it may be too late for him, but future Americans are demanding a more efficient and comprehensive system.

“I needed ‘Medicare for All’ yesterday. Millions of people need it today,” he told the committee.

House Speaker Nancy Pelosi hasn’t fully embraced single-payer, but she’s allowing chairmen to test the waters in a nod to labor unions and progressives who see the idea as a critical part of the party’s 2020 platform.

The plan is unpopular with insurers and drug companies, who see it as an existential threat, and it has no chance of becoming law under President Trump and a GOP-controlled Senate. Still, progressives took Tuesday’s hearing as a win.

“Momentum is growing across the country to guarantee health care as a human right, and this hearing is a critical step in that direction,” single-payer champions Sen. Bernard Sanders of Vermont and Reps. Pramila Jayapal of Washington and Debbie Dingell of Michigan said in a joint statement.

A spokeswoman for the House Ways and Means Committee confirmed that Chairman Richard Neal of Massachusetts, plans to hold his own hearing on the issue.

Though no date is set, the confirmation appeared to accept the challenge posed by Republicans, who said a committee with oversight of health issues should acknowledge the idea, which polls well but poses big questions about implementation and costs.

Witnesses before the Rules Committee said higher taxes on the wealthy may be one way to pay for the program, and that combining the fragmented streams of health spending into a single program might save money.

Even so, it won’t be easy to shift those costs onto the government, said Charles Blahous, a Republican witness and public trustee for the Social Security and Medicare programs.

“While total national health spending under [Medicare for All] is an important piece of policy information, federal lawmakers would not be able to avoid the central question of how to finance its costs to the federal budget,” testified Mr. Blahous, who’s studied the costs as a senior research strategist at George Mason University’s Mercatus Center.

Analyses of single-payer plans say it could cost north of $30 trillion over a 10-year budget window. That would inevitably mean higher taxes, and Republicans were quick to note the plan would upend the deep-rooted system of private insurance.

“Democrats are so confident Americans will love their one-size-fits-all government plan that they feel the need to ban the private sector from competing with it,” said Senate Majority Leader Mitch McConnell. “This is a fantasy pulled from the farthest corners of the left. But now, leading Democrats are proudly embracing it.”

Though Mr. Sanders has spoken about single-payer for decades, several of his 2020 presidential rivals are rallying around “Medicare for All,” including Sens. Elizabeth Warren of Massachusetts, Kamala D. Harris of California, Kirsten Gillibrand of New York and Cory A. Booker of New Jersey.

Recent polls suggest a majority of Americans support the idea, though support plummets when tradeoffs, such as potential wait times or limits on services and the end of private insurance, are floated.

Rep. Tom Cole, Oklahoma Republican, said Democrats should be focused on health care fixes “that we know can become law.”

Some Democrats say single-payer is a bridge too far for them, too. They prefer incremental measures, saying the best way to build on Obamacare is by authorizing a public option to compete with private plans.

Former Vice President Joseph R. Biden this week endorsed a public option, saying the health law he pushed with Mr. Obama was a critical step but didn’t finish the job.

“We have to stop this administration’s effort to gut it first, and then we have to move on and finish the job and make healthcare a right,” he told union members in Pittsburgh. “Health care is a right, not a privilege.”

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