Battle lines have been drawn as Bernie Sanders launches his latest attempt to establish a healthcare system that covers all 323 million Americans.

Standing in opposition to Sanders’ plan are what he calls the “most powerful and greedy forces in American society”: the pharmaceutical industry, insurance companies, Wall Street and the Republican party.

“The opposition to this will be extraordinary,” Sanders said in an interview in his Capitol Hill office, prior to the launch of his universal healthcare bill, known as “Medicare for All”.

“They will spend an enormous amount of money fighting us. They will lie about what is in the program. They will frighten the American people,” he said.

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Sanders has no illusions about the bill’s prospects in a Republican-controlled Congress, where it has virtually no chance of passing. But he says the time has arrived to have a debate he believes is fundamental: is healthcare a right or a privilege in America?

Sanders formally unveiled the bill at a packed press conference on Wednesday, with the backing of nearly a third of the Democratic caucus in the Senate – a record level of support for a bill he introduced just four years ago with only one signature, his own.

The Sanders plan would radically reform the American healthcare system, transitioning over the course of four years to a “Medicare for All” program, a single-payer system in which the federal government insures everybody, financed by an increase in taxes.

Sanders’ bill would establish a national health insurance program by gradually expanding Medicare – the federal health insurance program for people who are 65 or older and some younger Americans with disabilities and other illnesses – until it covered everybody.

Sanders said of the plan: “You’re going to the same private doctor that you went to. You’re going to go to the same hospital that you went to. The only difference is instead of having a Blue Cross Blue Shield [insurance] card – and having to argue with your insurance company – you’re going to have a Medicare for All card. That’s it.”



Everything from primary and preventive services to hospital stays would be covered under the plan, with no out-of-pocket costs on deductible and copays. It would also include access to abortion, in effect overturning the Hyde amendment, which bans federal funding for the procedure.

During the first year of the program, the eligibility age for the Medicare program would drop to 55, and all Americans under 18 would be added to the program. The eligibility age would gradually decrease until the fourth year, when everyone would receive a “universal Medicare card”.

Facebook Twitter Pinterest Bernie Sanders celebrates the 50th anniversary of Medicare and Medicaid two years ago. Photograph: Jacquelyn Martin/AP

Since Barack Obama ran for president promising to reform the healthcare system, public support for single-payer has climbed. Where 46% of the public supported such a system in 2008 and 2009, a recent Kaiser poll found 53% now support the idea.

But it was the Vermont senator who helped bring universal healthcare, a once fringe idea derided as a progressive fantasy, into the mainstream. Now, however, some supporters are wary that Democrats could fall into the same trap Republicans did with their campaign to “repeal and replace” Obamacare.

Sanders’ Medicare for All bill, like the Republicans’ repeal and replace effort, is a popular idea but leaves open crucial policy decisions and lacks, for now, details on how the system would be financed.

On Wednesday, Sanders’ team released an outline of various way to pay for single payer healthcare, including options to implement progressive taxes. Sanders said during the press conference that he wanted to foster a public debate on the best way to finance the program.

But in a sign of the major political and policy fights that lie ahead, the same Kaiser survey found that when respondents were told that a universal healthcare plan might give the government “too much control”, or that it might increase taxes, support dropped sharply. In those instances, the number of Americans opposed to the proposal rose from 43% to 62% and 60%, respectively.

With a hardened view of the political obstacles, Democratic leaders have declined to endorse the single-payer measure. The House minority leader, Nancy Pelosi, has said her focus is protecting Obama’s Affordable Care Act (ACA) from Republican attempts to tear it down. And Chuck Schumer, the Senate minority leader, has said Sanders’ plan is one of several pieces of legislation under consideration in his caucus.

And yet the bill is gaining steam among the Democratic party. Among the 15 senators co-sponsoring the bill are Elizabeth Warren, Kamala Harris, Kirsten Gillibrand, Cory Booker and Al Franken – all of whom are rumored to be considering a 2020 run for president .

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In the House of Representatives, a majority of Democrats have signed on to a similar measure introduced by John Conyers of Michigan, a bill he has brought forward in every Congress since 2003 without nearly as much support.

Republicans, bruised after a failed campaign to repeal the Affordable Care Act, are eager to use Sanders’ progressive plan to attack Democrats. Of the 10 Senate Democrats up for re-election in states Trump won, only one, Tammy Baldwin of Wisconsin, has signed on to the bill so far.

Senator John Barrasso, a Republican from Wyoming and an orthopedic surgeon, said on Tuesday the Sanders bill “is becoming the litmus test for the liberal left” and decried the program as exorbitantly costly. He pointed to Sanders’ home state, where legislators tried and failed to establish a single-payer system after experts estimated that running the program would require doubling taxes for residents of Vermont.

In a floor speech on Wednesday, the Republican wondered if Democrats had purposely injected a design flaw into the ACA, popularly known as Obamacare, to create the political momentum for universal healthcare.

“You had to wonder if Democrats actually wanted it to fail – so they could push for more Washington control, more government control over your healthcare,” Barrasso said. “You can call it the old Potomac two-step.”

Senator Claire McCaskill, a moderate Democrat up for re-election in Missouri, said a single-payer bill was “premature” but welcomed the debate. She said she would prefer to allow people between 55 to 65 to buy into the Medicare program.

Facebook Twitter Pinterest Senator John Barrasso suggested Democrats had built a design flaw into the ACA to create momentum for a universal healthcare plan. Photograph: Joshua Roberts/Reuters

Meanwhile, Democrats too have raised concerns that changing gears too quickly – shifting from defending Obamacare to overhauling it with a disruptive new plan – could put the healthcare law in jeopardy as Republicans continue to push for a repeal. Hours before Sanders unveiled his plan, Republicans introduced a healthcare plan that they presented as the last best hope for repealing the Affordable Care Act.

“The risk is getting distracted by a longer-term healthcare policy discussion when these guys are still rabid to gut the ACA,” said Senator Chris Murphy, a Democrat from Connecticut, who has not signed on to the bill as he is working on a more moderate plan.

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But for supporters of Sanders’ plan, such as Senator Richard Blumenthal, a Democrat from Connecticut and one of the bill’s 16 sponsors, universal healthcare is “an idea whose time has come”.

“There should be no question about what our goal is: provide access to everyone,” Blumenthal told reporters on Tuesday. “There is nothing about the politics of the moment of the ACA that precludes supporting Medicare for All as the ultimate goal.”

Sanders said he was open to other approaches that push the country toward universal healthcare but said he believed that Medicare for All, modeled after the Canadian healthcare system, was the most logical path.

He acknowledged the hefty price tag. But he argued that the US spent more per capita on healthcare than countries that guarantee healthcare as a right, such as Canada, France and Germany. And despite the country spending more, 28 million Americans remain uninsured, infant mortality rates are higher and life expectancy is shorter.

Making universal healthcare a legislative reality will require massive grassroots mobilization and an education campaign, Sanders said. On Wednesday, Sanders unveiled the bill with the backing of at least two dozen left-leaning organizations that will help mobilize support in capitals and statehouses across the country.

“I don’t want anyone to think that this is a struggle that’s going to be won tomorrow. And I don’t want anyone to think that [the Senate majority leader] Mitch McConnell is coming onboard this legislation. He is not. Nor is [the House speaker] Paul Ryan,” Sanders said.

“But there is growing support among the American people and we will win this struggle.”