text: Throughout his insurgent campaign for the Democratic presidential nomination in 2016, one of Bernie Sanders’s chief rallying points was to question why the United States is the “only major country on Earth not to guarantee health care to all people.” Having taken the issue into the political mainstream, the independent senator from Vermont is turning his broad idea into something more concrete by rolling out a “Medicare for All” bill on the floor of the Senate on Wednesday. 
   
   Related: If Bernie Sanders wants to win 2020 election, he needs to control his supporters, Democrats say 
   
   Even Sanders has acknowledged that it’s “obvious” the bill has no chance of passing with the Senate (and House) controlled by Republicans. But he has already succeeded in pushing the issue further into the spotlight and pressuring Democrats to jump on board. Support for the bill has become a practical litmus test for the party’s 2020 presidential hopefuls. 
   
   After California Senator Kamala Harris signed last month, other potential 2020 candidates—Senators Cory Booker, Elizabeth Warren and Kirsten Gillibrand—were among those to take the number of bill co-sponsors to 11 as of Tuesday afternoon. 
   
   The simple tenant of the proposal is to put in place in the U.S. a single-payer system akin to that used in the U.K., France, Australia, Canada and others. These can differ from fully government-run national health services, as in the U.K., to France’s public/private hybrid. Whatever route they take, though, they offer universal health care and no requirement to get insurance through an employer. In the U.S., the current Medicare safety net, which now covers only people over age 65, would apply to all Americans. 
   
   “Health care must be recognized as a right, not a privilege,” Sanders argues. “Every man, woman and child in our country should be able to access the health care they need regardless of their income. The only long-term solution to America’s health care crisis is a single-payer national health care program.” 
   
   Sanders has said that the plan would in large part be paid for by a progressive tax system that would have the richest households paying more income, capital gains and estate taxes, among others. Existing health care expenditures would also go toward the plan. According to Sanders, his plan would save the American people and businesses $6 trillion over the next decade. 
   
   While there is widespread evidence to support the notion that a single-payer system is far more cost-effective than the current model in the United States, the exact savings under Sanders’s plan remains a topic for much debate. 
   
   Still, although Republicans and even more moderate Democrats aren’t rushing to sign onto a single-payer system anytime soon, polls have showed that Americans have already moved in that direction. A June 2017 Pew Research Center survey found that 60 percent of Americans said the federal government should be responsible for ensuring health care coverage for all Americans. 
   
   Update: An earlier version of this story misspelled the name of Kirsten Gillibrand. This has been corrected. ||||| Vermont Sen. Bernie Sanders and his call for a government-run health care system are back. On Wednesday, he is laying out a bill that proposes “Medicare for all,” replacing a U.S. health care system dominated by employer-provided insurance — with lots of assorted co-payments and deductibles — to a single-payer approach in which higher taxes fund a system where individuals don’t pay directly for health care. Influential Democratic senators and potential 2020 candidates Cory Booker (New Jersey), Kirsten Gillibrand (New York), Kamala Harris (California), Jeff Merkley (Oregon) and Elizabeth Warren (Massachusetts) have embraced the idea. 
   
   “Medicare for all” is going absolutely nowhere anytime soon under a Republican-controlled Congress and President Trump. But here’s the big question: Is it going to become one of the central goals of the Democratic Party and a defining feature of the campaign of whichever Democrat is the party’s nominee in 2020? This seems very likely, at least right now, given the political forces pulling Democrats to the left. But I’m not totally sure, mainly because there are some clear political and policy reasons for Democrats to avoid becoming the party of single-payer. 
   
   Why the Democratic nominee may have to strongly embrace Medicare-for-all 
   
   
   
   1. Some of the party’s most popular figures are already behind it. 
   
   FiveThirtyEight’s Nate Silver and Vox’s Matt Yglesias have argued that Sanders is, at least right now, the front-runner for the Democratic nomination for president. If Sanders, who is 76, opts not to run, the 68-year-old Warren seems like an obvious person for Sanders backers to embrace, as she shares many of the same liberal and populist positions. Harris, the daughter of an Indian woman and a Jamaican man, was elected district attorney in San Francisco and has won statewide election three times in California, which is about 40 percent Latino. A candidate with appeal to Asian, black and Latino voters as well as upper-income whites in cities like San Francisco would be formidable in a Democratic primary. I think it’s fair to say that all three of these senators would rank among the top 10 current contenders for the Democratic nomination. Booker is rumored to be considering a run as well. (The online betting site PredictIt ranks these four as among the top five people likely to get the Democratic nomination in 2020, along with former Vice President Joe Biden.) 
   
   So Booker, Harris, Sanders and Warren already being for Medicare-for-all greatly increases the chances of the Democratic nominee in 2020 supporting this policy, simply because one of that quartet has a strong chance of being the nominee. And staking out this position, well to the left of where the party was even last November, puts pressure on Biden, New York Gov. Andrew Cuomo and other Democrats who might be considering a 2020 run. Even if one of those candidates privately disagrees with the merits or the strategy of pushing Medicare-for-all, he or she might opt to support the idea to avoid being tagged as insufficiently liberal and therefore out of step with the party’s activist base. 
   
   This is how presidential nomination processes often work. In the campaign for the 2008 Democratic nomination, John Edwards came out with a comprehensive health insurance plan, effectively forcing Barack Obama and Hillary Clinton to do the same. (The Edwards plan, with its individual mandate and emphasis on creating health insurance marketplaces, was one of the building blocks of what eventually became the Affordable Care Act.) 
   
   This intra-party competition is the biggest and clearest reason to assume Medicare-for-all will become party dogma. 
   
   2. The Democrats are becoming a more liberal party. 
   
   In 2012, according to the Pew Research Center, about 19 percent of self-described Democrats considered themselves conservative, about 36 percent said they were liberal, and about 41 percent said moderate. Today, a plurality of Democrats (48 percent) describe themselves as liberal. A shift to Medicare-for-all would be in line with this march to the left. 
   
   And the party’s elected officials are headed there, too. The new “Better Deal” agenda that congressional Democrats unveiled in July includes a number of Sanders-inspired populist ideas. The party rebranding effort, for example, calls for requiring prescription drug companies to submit an explanation to the U.S. government if they increase the price of a drug by too much. 
   
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   In this environment, it is much easier to see a centrist Democrat like Cuomo essentially accepting Medicare-for-all as a stance he must take rather than pushing Democratic activists away from Medicare-for-all. 
   
   3. The Obamacare experience is moving Democrats. 
   
   In 2009 and 2010, when he was stumping for the Affordable Care Act, Obama often highlighted the private marketplaces that would be set up under the law. He mentioned how the ACA would expand Medicaid less often, perhaps with an eye on winning over more independent or conservative-leaning voters who might be leery of more government intervention in the health care system. 
   
   But in practice, the private marketplaces have been beset with high rates and insurers fleeing the system, while Medicaid expansion has been popular. This year, as Republicans sought to repeal the ACA, Democrats hammered them on Medicaid, which would have been cut by billions of dollars in the GOP repeal proposals. This defense of Medicaid by Democrats seemed to force even Republican senators like Nevada’s Dean Heller to say they were committed to defending the program. 
   
   “One thing has saved the Affordable Care Act from Republicans’ efforts to repeal it: When the votes counted, at least three Republican senators — along with every Democrat in the Senate — could not accept massive cuts to Medicaid,” wrote Mark Schmitt, who runs the Political Reform program at the D.C.-based think tank New America and was a longtime Democratic staffer on Capitol Hill. 
   
   Putting more people on government-funded health care programs is an idea that Democrats often favor but sometimes sidestep because they think it is too politically difficult to get adopted. (Obama, in an interview with Vox in January, essentially said that he thought a single-payer system would be more effective, but didn’t think it was possible to get that passed in 2009 or 2010.) The ACA experience has led Democrats — even those who strongly promoted and defended Obamacare — to argue that the ACA has not fixed enough of the country’s health care problems and push for a more comprehensive solution. 
   
   Party officials now believe that the public may be open to such a proposal. “It’s always the biggest applause line,” U.S. Rep. John Yarmuth of Kentucky, a Democrat, told me. 
   
   Warren, in a blog post on her website, carefully praised the achievement at the center of Obama’s legacy while signaling a desire to move beyond it, writing: “We owe a huge debt to President Obama. Because of the Affordable Care Act, health care coverage is better. … But there’s so much more we could do right now to bring down the costs of quality health care for every American.” 
   
   Why the Democratic nominee may be not strongly for Medicare-for-all. 
   
   
   
   1. A Medicare-for-all candidate may not win the primary. 
   
   There was a lot of talk in 2013 about how the Republican presidential nominee three years later would be more liberal on immigration issues than past candidates because of how badly Republicans did in the 2012 election with non-white voters. One of the people pushing that way on immigration (Marco Rubio) also seemed a likely top-tier presidential candidate, the way Booker, Harris, Sanders and Warren are. We know how that turned out. 
   
   Some combination of Booker, Harris, Sanders and Warren may not run for president. They might all run and lose. And the candidate who wins the Democratic nomination could be someone who breaks from the Medicare-for-all view, or at least says that he or she is open to other ideas to improve America’s health care system. Maybe that will be a figure like Biden or Colorado Gov. John Hickenlooper, either of whom might run for president and could position themselves as the center-left alternative to the more liberal candidates. In fact … 
   
   2. Medicare-for-all is not the only way to expand government-run health insurance. 
   
   Liberal wonks, such as Paul Krugman, are not so sure about Medicare-for-all. They argue that such a system is actually extremely complicated to create and that the final product might irritate the millions of Americans who have insurance through their employer and like it. 
   
   So some Democrats are proposing ideas like Medicare-for-some (U.S Sen. Chris Murphy of Connecticut) or Medicaid-for-some (U.S. Sen. Brian Schatz of Hawaii). The general idea is that people who are uninsured could buy (or be enrolled for little cost if they don’t make much money) into these programs. 
   
   This kind of a policy would be less of a shift to the left. Obama proposed a “public option” in 2009 that would have been similar to the ideas of buying into Medicare or Medicaid that Murphy and Schatz are touting. He dropped the idea after some more conservative Democrats opposed it, but by the end of his presidency, Obama had strongly embraced the idea. Hillary Clinton included a public option in her 2016 platform, though it was not a big feature of her campaign. 
   
   Maybe a more moderate Democrat could campaign on expanded Medicaid and Medicare but downplay the “for all” part. And that might have appeal because … 
   
   3. Many Democratic voters are not liberal. 
   
   I described earlier how liberals are ascendant in the Democratic Party. But according to Pew, the combined group of self-identified moderates (36 percent) and conservatives (15 percent) is as large as the liberals. Whites, people with college degrees, and millennials are disproportionately liberal, while other demographics in the party are not. According to Pew, 55 percent of white Democrats consider themselves liberal, compared with 28 percent of black Democrats and 41 percent of Latinos. About 60 percent of Democrats with postgraduate degrees consider themselves liberals, compared with about 37 percent of Democrats with a high school degree or less. 
   
   You could imagine New Orleans Mayor Mitch Landrieu pitching himself as the candidate who can appeal to working-class whites and more moderate Democrats. And part of that pitch could be running on a health care plan that is more likely to be passed into law than Medicare-for-all. 
   
   In June, Pew polled Americans on creating a “single-payer” health care system. Only 33 percent of the public overall supported the idea, although 52 percent of Democrats backed it. I assume Democratic support for Medicare-for-all will grow with more leading figures in the party embracing it. Also, the poll asked people about a single national health insurance system run by the government, not “Medicare-for-all,” which I suspect is a much more popular notion. But the survey did not ask respondents about “Medicare-for-all” versus “Medicare-for-some,” which might also be a popular idea. So public opinion on this issue could well shift in a number of directions. 
   
   I’m inclined to think that whoever receives the Democratic nomination in 2020 will support Medicare-for-all, either because he or she truly believes in the idea or because party politics effectively force this. I’m not so sure that this idea will ever become U.S. policy — or even come to a vote in Congress. But its embrace by Booker, Harris and Warren less than a year after the election tells us two important things about American politics right now: Sanders lost the Democratic Party’s nomination, but he may have emerged as the party’s intellectual leader. And the Democrats appear to have concluded from 2016 that, at least on economic issues, they should move left, not right. ||||| Bernie Sanders’ single-payer health care plan has won over most other liberal senators, including many weighing 2020 bids. 
   
   The rest of the Democratic Party is another matter. 
   
   Story Continued Below 
   
   As Sanders prepares to unveil his Medicare for All legislation on Wednesday, most of the party’s congressional leaders and vulnerable Senate incumbents are steering clear. Even as the left celebrates Sanders’ ability to push the Democratic agenda leftward after his primary challenge to Hillary Clinton last year, that success appears to have its limits. 
   
   Senate Minority Leader Chuck Schumer told reporters that he would be “looking at all of” the party’s “many good” proposals to expand health care access, but declined to back Sanders. House Minority Leader Nancy Pelosi declared that her priority is shielding Obamacare from a GOP repeal push that’s not yet dead for good. 
   
   Connecticut Sen. Chris Murphy, one of the few Democrats subject to 2020 speculation who has not signed on to the Sanders bill, warned against letting the party’s attention slip to “longer-term health care policy” while the future of the Affordable Care Act remains up for debate. 
   
   “I think the risk is that we get distracted,” Murphy told reporters. “September’s not done. They can still ram through a repeal bill.” 
   
   Wisconsin Sen. Tammy Baldwin on Tuesday became the single-payer bill’s first supporter from the class of Senate Democrats up for reelection next year in states Trump carried. But other politically imperiled incumbent Democrats have said no to Sanders. 
   
   POLITICO Pulse newsletter Get the latest on the health care fight, every weekday morning — in your inbox. Email Sign Up By signing up you agree to receive email newsletters or alerts from POLITICO. You can unsubscribe at any time. 
   
   Sen. Claire McCaskill said in a brief interview that lawmakers have more work to do to keep health care costs in check “before we would think about expanding that [Medicare] system to everyone.” 
   
   Single-payer on a national level would have “a lot of problems,” McCaskill added, although she came out in support of allowing individuals as young as 55 to buy into Medicare. That idea is also backed by Baldwin and two other red-state Democrats up for reelection next year who are declining to endorse Sanders’ bill: Sens. Sherrod Brown of Ohio and Debbie Stabenow of Michigan. 
   
   Stabenow, also a member of Democratic leadership, said Tuesday that she would keep working on her Medicare-at-55 plan “because I think there is some bipartisan interest in that.” She said the party’s first order of business should be shoring up the Obamacare markets, followed by other goals. 
   
   “The first thing has to be to protect the health care people have now and stabilize markets, no question,” Stabenow said. “But we need to focus on lowering the cost of prescription drugs and providing more health care, more health care options.” 
   
   Improving the Affordable Care Act is the core of a bipartisan effort in the Senate health committee. The panel's ranking member, Sen. Patty Murray of Washington, a member of the Democratic leadership, also declined to endorse Sanders’ bill on Tuesday. 
   
   “There’s a lot of Democratic ideas out there, and I haven’t had the chance to look at all of them,” Murray said, adding that she remains “very focused” on the committee’s work. 
   
   Republicans have already seized on the high costs of imposing a single-payer system — which Sanders’ presidential campaign proposed to pay for with new taxes on employers and wealthy individuals — to hammer Democrats for supporting the idea. The National Republican Senatorial Committee criticized Baldwin on Tuesday for backing “the left’s radical plans for government-run health care.” 
   
   Sen. John Barrasso (R-Wyo.), a member of GOP leadership, also reminded reporters Tuesday that Sanders’ home state of Vermont had to back away from its own single-payer health proposal after the economic burden proved too onerous. 
   
   Backers of the Sanders bill acknowledge that single-payer is a heavy political lift but describe it as an important benchmark for Democrats’ future. As the party hones its identity beyond opposition to Trump’s agenda, single-payer fans see enough room to set big long-term goals while waging the shorter-term battle to protect Obamacare. 
   
   “There’s nothing about the politics of the moment or the Affordable Care Act that in any way precludes supporting Medicare-for-all as the ultimate goal, and there’s a clear path to it,” said Sen. Richard Blumenthal. The Connecticut Democrat signed on to the bill Tuesday. 
   
   Sen. Al Franken (D-Minn.), who has been mentioned as a possible 2020 candidate, also expects to sign on to the single-payer bill, a spokesman said Tuesday. Franken noted that his cosponsorship reflects the bill's status as a long-term goal while the party continues short-term work on Obamacare. 
   
   "This bill is aspirational, and I’m hopeful that it can serve as a starting point for where we need to go as a country," Franken said in a statement. "In the short term, however, I strongly believe we must pursue bipartisan policies that improve our current health care system for all Americans — and that’s exactly what we’re doing right now in the Senate Health Committee, on which both Senator Sanders and I sit." 
   
   For other Democrats, however, the idea’s time may have not yet come. 
   
   Ben Cardin said in an interview that he supports universal health coverage but has "certain concerns" about using single-payer to achieve that goal. 
   
   “There’s the political issue, but there’s also the issue about how you make sure there will be adequate resources put into health care,” the Maryland Democrat said. 
   
   Sen. Joe Manchin of West Virginia, a member of leadership who's among the GOP's top targets in 2018, walked a fine line Tuesday as Republicans revived his past comments welcoming a discussion of a government-run health care system. 
   
   "I am skeptical that single-payer is the right solution, but I believe that the Senate should carefully consider all of the options through regular order so that we can fully understand the impacts of these ideas on both our people and our economy," Manchin said in a statement on Tuesday. 
   
   Sen. Dianne Feinstein, facing consternation from liberals in her home state of California — where an effort to enact single-payer statewide ran aground this year — said that she would want to see the price tag before taking a position on Sanders' bill. 
   
   "My understanding is, the cost of single-payer is enormous," Feinstein said, noting that she supports a public option for health insurance outside the private market. 
   
   Murphy and Hawaii Sen. Brian Schatz have offered their own ideas to shift the party's health care debate leftward without going as far as Sanders' plan would. The Connecticut Democrat is working on legislation creating a Medicare buy-in for all individuals and businesses, while Schatz told POLITICO he expects to release a Medicaid buy-in proposal later this month. 
   
   Murphy said he would not sign on to Sanders' bill before its release, urging "our party to take some time and look at all the options available to us before we decide on one unitary route." 
   
   And even as some Sanders-aligned activists spook Democrats with talk of possible primary challenges to candidates who don't support the single-payer plan, other liberals were content to cheer the Vermont independent for attracting more than one-quarter of the caucus to his legislation. Progressive Change Campaign Committee co-founder Adam Green, who worked with Murphy on the Medicare buy-in plan, said that "Democrats are increasingly wrapping themselves in the flag of" Medicare for all without closing off other options that advance the ball. 
   
   "This is how big ideas like expanding Social Security and debt-free college were moved into the mainstream — the North Star gets put up, solid organizing is done, critical mass is built in Congress and on the campaign trail, and party consensus falls into place," Green said by email. "It's happening now." ||||| Sen. Bernie Sanders, I-Vt., second from right, declines to speak with a reporter as he walks to a luncheon with Democrats on Capitol Hill in Washington, Tuesday, Sept. 12, 2017. (AP Photo/Susan Walsh) (Associated Press) 
   
   WASHINGTON (AP) — Liberal Sen. Bernie Sanders is ready to unveil his bill for starkly reshaping the country's current hodge-podge health care system into one where the government provides medical insurance for everybody. 
   
   Republican senators are preparing to roll out details of a last-ditch effort to repeal and replace President Barack Obama's health care law. 
   
   The rival packages have little in common, other than the likelihood that neither is going anywhere. 
   
   Seven weeks after the GOP drive to uproot Obama's 2010 health care law crashed in the Senate, two Republican senators, Lindsey Graham of South Carolina and Louisiana's Bill Cassidy, on Wednesday were releasing their plan for trying again. 
   
   They've struggled for weeks to round up sufficient support for the package. It would cut and reshape Medicaid, disperse money spent under Obama's law directly to states and erase Obama's penalties on people who don't purchase coverage. 
   
   No. 3 Senate GOP leader John Thune of South Dakota said Graham and Cassidy would need "a double-double bank shot" to prevail, a joking reference to an impossible basketball shot. 
   
   Like the failed Senate GOP repeal effort in July, the Graham-Cassidy push will get zero Democratic support. That means Senate Majority Leader Mitch McConnell, R-Ky., will need 50 of the 52 Republican senators, a margin he couldn't reach in July and is struggling to reach now. 
   
   Despite badgering by President Donald Trump that he keep trying, McConnell has expressed no interest in staging yet another vote that produces an embarrassing rejection by the GOP-controlled Senate. Conservatives are wary because the bill falls short in erasing Obama's wide-ranging coverage requirements. 
   
   "I don't think this bill will go anywhere," said Sen. Rand Paul, R-Ky. 
   
   Meanwhile, Sanders is introducing his bill for essentially expanding the Medicare health insurance program for the elderly to all Americans. 
   
   The progressive wing of the Democratic Party backs his bill, which would make health care less expensive and less complicated for many people and businesses. It would cover the 28 million Americans remaining uninsured despite Obama's law. 
   
   People would simply flash a card and be entitled to coverage, without out-of-pocket expenses like deductibles, according to Sanders aides. They would pay income-adjusted premiums, with the poorest paying nothing but the rich and profitable corporations seeing higher taxes, and people and businesses would no longer owe premiums to insurers. 
   
   Some Democrats fear the Vermont independent is exposing them to a lose-lose choice. 
   
   Don't support Sanders' plan and risk alienating the party's liberal, activist voters, volunteers and contributors. Back it and be accused by Republicans of backing a huge tax increase and government-run health care, and taking away employer-provided coverage for half the country that many people like. 
   
   Sanders rejects that. 
   
   "Because the people in this country want to move toward a Medicare-for-all system, that is divisive?" he said in an interview Tuesday, citing polls showing growing support. 
   
   At least 12 other Senate Democrats signed onto Sanders' bill by late Tuesday, including four potential presidential contenders: Kamala Harris of California, Massachusetts' Elizabeth Warren, New York's Kirsten Gillibrand and Cory Booker of New Jersey. 
   
   "It may be a good strategy toward getting the nomination" to be the Democratic presidential nominee, said Ron Pollack, chair emeritus of the liberal Families USA, who backs universal coverage but thinks Sanders' plan is politically unrealistic. "I don't think it's a good strategy for the general election." 
   
   To cover themselves, several Democrats are introducing their own bills that expand coverage without going as far as Sanders, including possible presidential aspirants Sens. Chris Murphy of Connecticut and Ohio's Sherrod Brown. Several Democrats facing tough re-election battles next year in GOP-leaning states say they want to focus on strengthening Obama's existing law, including Montana's Jon Tester and Missouri's Claire McCaskill. 
   
   Republicans say they're ready. 
   
   "We welcome the Democrats' strategy of moving even further left," said Katie Martin, spokeswoman for the Senate GOP's campaign organization. 
   
   A third effort, a bipartisan attempt to shore up individual insurance markets around the country, is showing early signs that the sides are having problems reaching agreement. 
   
   Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., hope to reach a deal on continuing for at least a year the federal payments to insurers that Trump has threatened to halt. Republicans are also insisting on easing the Obama law's coverage requirements, which Democrats don't want to do. 
   
   Alexander said Tuesday that Republicans want "real state flexibility" to let insurers offer "a larger variety of benefits and payment rules." 
   
   Murray said she worried the GOP wants to "wind up increasing out-of-pocket costs for patients and families." That's something Democrats oppose. 
   
   McConnell said the Alexander-Murray talks "are underway and we'll see where they go." ||||| These crawls are part of an effort to archive pages as they are created and archive the pages that they refer to. That way, as the pages that are referenced are changed or taken from the web, a link to the version that was live when the page was written will be preserved.Then the Internet Archive hopes that references to these archived pages will be put in place of a link that would be otherwise be broken, or a companion link to allow people to see what was originally intended by a page's authors.The goal is to fix all broken links on the web . Crawls of supported "No More 404" sites. ||||| 2. Does single-payer work well in the countries that have it? 
   
   Generally, yes, it works very well. Costs are lower across Europe, Canada and Australia, where government plays a bigger role in medical care than here, and citizens in many of those places live longer than Americans. This is the single best argument for single-payer. 
   
   “In America, we should join every industrialized country and guarantee health care to all Americans as a right,” Sanders told Stephen Colbert last week. 
   
   3. Could the United States keep its distinctive advantages under single-payer? 
   
   The American system is expensive and inefficient. It also produces many of the world’s most important medical innovations — new drugs, devices, treatments and the like — and is home to many of the best hospitals and researchers. That’s why wealthy people from other countries often come here for treatment. 
   
   It’s certainly conceivable that a single-payer system could retain these advantages while making American health care less wasteful. But I’d like to hear a fuller explanation from advocates about how it all would work. 
   
   4. How will single-payer overcome its political obstacles? 
   
   Even if single-payer reduces costs and lifts quality, the transition would be very tricky. Many people would be forced to change insurance plans even if they liked their current coverage. (Ask Barack Obama how popular that would be.) And money that Americans are now spending on private health care would instead have to be funneled into higher taxes. 
   
   Sanders deserves credit for both the passion and detail he is bringing to the subject. Yet his plan from the 2016 campaign was not realistic about the necessary tax increase, as an analysis by the Urban Institute, a left-leaning think tank, showed. The recent failure of single-payer in left-leaning Vermont, which helped end the governor’s political career, shows how brutal the politics are. 
   
   5. Is this a yes-or-no subject, or is there a middle ground? 
   
   Ah, my favorite question. There is indeed a middle ground. ||||| Good Friday morning. Situational awareness: "Bomb cyclone" flight cancellations at U.S. airports yesterday, per FlightAware: 4,395. Cancellations today: 1,128. 
   
   1 big thing: What Wolff got most right @realDonaldTrump There are definitely parts of Michael Wolff's " of Michael Wolff's " Fire and Fury " that are wrong, sloppy, or betray off-the-record confidence. But there are two things he gets absolutely right, even in the eyes of White House officials who think some of the book's scenes are fiction: his spot-on portrait of Trump as an emotionally erratic president, and the low opinion of him among some of those serving him. Why it matters: Wolff captures the contempt some Trump aides have for the president and his family. Axios' Jonathan Swan notes that this includes people you see trumpeting their loyalty to him. 
   
   Wolff captures the contempt some Trump aides have for the president and his family. Axios' Jonathan Swan notes that this includes people you see trumpeting their loyalty to him. So Wolff's liberties with off-the-record comments — while ethically unacceptable to nearly all reporters — have the effect of exposing Washington's insider jokes and secret languages, which normal Americans find perplexing and detestable. In the past year, we have had many of the same conversations with the same sources Wolff used. We won't betray them, or put on the record what was off. But, we can say that the following lines from the book ring unambiguously true: How Trump processes (and resists) information: "It was during Trump's early intelligence briefings … that alarm signals first went off among his new campaign staff: he seemed to lack the ability to take in third-party information." 
   
   "Or maybe he lacked the interest; whichever, he seemed almost phobic about having formal demands on his attention." 
   
   "Trump didn't read. He didn't really even skim. ... [H]e could read headlines and articles about himself, or at least headlines on articles about himself, and the gossip squibs on the New York Post's Page Six." 
   
   "Some ... concluded that he didn't read because he just didn't have to, and that in fact this was one of his key attributes as a populist. He was postliterate — total television." 
   
   "[H]e trusted his own expertise — no matter how paltry or irrelevant — more than anyone else's. What's more, he had an extremely short attention span, even when he thought you were worthy of attention." Instinct over expertise: "The organization ... needed a set of internal rationalizations that would allow it to trust a man who, while he knew little, was entirely confident of his own gut instincts and reflexive opinions, however frequently they might change." 
   
   "Here was a key Trump White House rationale: expertise, that liberal virtue, was overrated." Ill-preparedness: "[T]he president's views of foreign policy and the world at large were among [his White House's] most random, uninformed, and seemingly capricious aspects. His advisers didn't know whether he was an isolationist or a militarist, or whether he could distinguish between the two." 
   
   "He was enamored with generals and determined that people with military command experience take the lead in foreign policy, but he hated to be told what to do." 
   
   "In the Trump White House, policy making ... flowed up. It was a process of suggesting, in throw-it-against-the-wall style, what the president might want, and hoping he might then think that he had thought of this himself." Low regard by key aides: "He spoke obliviously and happily, believing himself to be a perfect pitch raconteur and public performer, while everyone with him held their breath. 
   
   "If a wackadoo moment occurred on the occasions … when his remarks careened in no clear direction, his staff had to go into intense method-acting response. It took absolute discipline not to acknowledge what everyone could see." 
   
   "At points on the day's spectrum of adverse political developments, he could have moments of, almost everyone would admit, irrationality. When that happened, he was alone in his anger and not approachable by anyone." 
   
   "His senior staff largely dealt with these dark hours by agreeing with him, no matter what he said." Be smart: More than half a dozen of the more skilled White House staff are contemplating imminent departures. Many leaving are quite fearful about the next chapter of the Trump presidency. 
   
   2. How to sell a book Letter from Trump's lawyer to Wolff and Steve Rubin, president and publisher of Henry Holt President Trump is so furious about Michael Wolff's book that some aides are just trying to avoid him. Key aides tried to talk him out of legal threats against the author and Steve Bannon, the key source. 
   
   tried to talk him out of legal threats against the author and Steve Bannon, the key source. Lawyers laughed: Does Trump really want to give discovery to Michael Wolff? 
   
   Does Trump really want to give discovery to Michael Wolff? But Trump was insistent on following a tactic he frequently used in business — rattling cages with lawyers' letters that resulted in no actual legal action. 
   
   was insistent on following a tactic he frequently used in business — rattling cages with lawyers' letters that resulted in no actual legal action. His demand that the publisher withhold the book (POTUS needs to see "The Post," with its takeaway on prior restraint) was a publisher's impossible dream that had the predictable effect: more publicity and presales. 
   
   that the publisher withhold the book (POTUS needs to see "The Post," with its takeaway on prior restraint) was a publisher's impossible dream that had the predictable effect: more publicity and presales. The publisher issued this statement: "Henry Holt confirms that we received a cease and desist letter from an attorney for President Trump. We see 'Fire and Fury' as an extraordinary contribution to our national discourse, and are proceeding with the publication of the book." 
   
   issued this statement: "Henry Holt confirms that we received a cease and desist letter from an attorney for President Trump. We see 'Fire and Fury' as an extraordinary contribution to our national discourse, and are proceeding with the publication of the book." Not only that: "Due to unprecedented demand, we are moving the on-sale date for all formats ... to [today] from the [previous] on-sale date of [next] Tuesday." 
   
   "Due to unprecedented demand, we are moving the on-sale date for all formats ... to [today] from the [previous] on-sale date of [next] Tuesday." In D.C., Kramerbooks started selling copies at midnight. P.S. WashPost Style front, "Breitbart may see a Bannon backlash," by Paul Farhi: "The website and its chairman found themselves isolated ... after Bannon's comments ... caused a backlash inside the White House, among rival conservative media outlets and among Trump supporters." 
   
   and its chairman found themselves isolated ... after Bannon's comments ... caused a backlash inside the White House, among rival conservative media outlets and among Trump supporters." "Bannon's comments ... prompted a key backer, the billionaire Mercer family, to withdraw financial support for Bannon's political activities. So far, however, the Mercers have not signaled that they will walk away from Breitbart itself, which would be a crippling blow." Be smart: Key conservatives tell us Bannon could wind up being ousted from Breitbart. 
   
   3. Is obstruction the new collusion? "Legal experts said that of the two primary issues ... Mueller appears to be investigating — whether Mr. Trump obstructed justice ... and whether there was collusion between the Trump campaign and Russia — there is currently a larger body of public evidence tying the president to a possible crime of obstruction," the N.Y. Times' Michael Schmidt writes in the paper's lead story: "Mueller has ... substantiated claims that [former FBI Director James] Comey made in a series of memos describing troubling interactions with the president before he was fired in May." 
   
   substantiated claims that [former FBI Director James] Comey made in a series of memos describing troubling interactions with the president before he was fired in May." "Mueller has also been examining a false statement that the president reportedly dictated on Air Force One in July ... about a meeting that Trump campaign officials had with Russians in 2016." 
   
   been examining a false statement that the president reportedly dictated on Air Force One in July ... about a meeting that Trump campaign officials had with Russians in 2016." But, but, but: "[I]t could be difficult to prove that the president, who has broad authority over the executive branch, including the hiring and firing of officials, had corrupt intentions when he [ousted] the F.B.I. director." 
   
   4. Bugs named Meltdown and Spectre "The disclosure of security flaws in computer chips dealt Intel Corp.what seemed like a sudden crisis, but behind the scenes it and other tech companies and experts have been grappling with the problem for months," the Wall Street Journal reports on the front page: "Apple ... became the latest tech giant to acknowledge it was affected by the vulnerabilities. The company said all iPhones, iPads and Mac computers were exposed, and that it already issued updates to fix the flaws." 
   
   the latest tech giant to acknowledge it was affected by the vulnerabilities. The company said all iPhones, iPads and Mac computers were exposed, and that it already issued updates to fix the flaws." "The flaws, which could allow hackers to pilfer sensitive information like passwords, affect most modern chips from an array of companies." "Nonetheless, the impact on Intel is likely to be minimal ... Intel said it expects by the end of next week to have issued software updates for more than 90% of processors introduced in the past five years." 
   
   which could allow hackers to pilfer sensitive information like passwords, affect most modern chips from an array of companies." Why it matters: "The issue called into question the security of Intel's products, and requires many customers to take action to protect their systems." "It also highlights how the growing complexity in chips and the software that runs on them makes them difficult to lock down and allows them to harbor flaws that can go undetected for years." 
   
   "The issue called into question the security of Intel's products, and requires many customers to take action to protect their systems." Go deeper: Axios' Ina Fried on the chip vulnerability 
   
   5. Global economy absorbs Trump "2017 turned out to be the global economy's best year since 2010, according to the International Monetary Fund, and 2018 looks even better," the WashPost's David Lynch writes on A1: The takeaway: "[T]he contrast between Trump's inflammatory rhetoric and the placid economic scene is striking." "Investors and corporate executives ... have learned to cope with an unpredictable president, often by ignoring his most provocative statements." 
   
   "[T]he contrast between Trump's inflammatory rhetoric and the placid economic scene is striking." The big picture : "Economics dominated politics last year outside the United States, too. In Europe, fears that ascendant populism in Britain, Poland, and Hungary would destabilize the E.U. proved exaggerated. And in Asia, prosperity surged despite rising tensions on the Korean Peninsula." 
   
   : "Economics dominated politics last year outside the United States, too. In Europe, fears that ascendant populism in Britain, Poland, and Hungary would destabilize the E.U. proved exaggerated. And in Asia, prosperity surged despite rising tensions on the Korean Peninsula." What's next: "[S]ome foreign executives are acting on concerns that the president may finally erect barriers against countries that sell more to the United States than they buy. ... Japanese companies [including] Toyota ... have stepped up investments in U.S.-based research, production and distribution." N.Y. Times Quote of the Day ... From a front-page James Stewart "Common Sense" column, "The Dow Hits 25,000: The Party Will End One Day, but When?": James Stack, a market historian and president of InvesTech Research: "A correction would be healthy. The longer we go without one, the greater the risk this will end badly." 
   
   6. Trump, GOP leaders to Camp David today The reflecting pool was frozen yesterday at the Capitol. (AP's Jose Luis Magana) Republicans have begun the year divided over whether their legislative agenda should include the use of a special budget tool (reconciliation) allowing them to pass legislation without Democrats — and whether to use it for health care or a welfare overhaul, Axios' Caitlin Owens the year divided over whether their legislative agenda should include the use of a special budget tool (reconciliation) allowing them to pass legislation without Democrats — and whether to use it for health care or a welfare overhaul, Axios' Caitlin Owens writes What to watch: This will be discussed when GOP leaders meet with President Trump at Camp David beginning this afternoon. 
   
   This will be discussed when GOP leaders meet with President Trump at Camp David beginning this afternoon. The takeaway: While Speaker Ryan is eager to tackle welfare and entitlements, Senate Majority Leader Mitch McConnell has said it's not happening. 
   
   7. Fears of weed crackdown by feds "The buzz kill long dreaded in the marijuana industry came just days after California opened what is expected to be the world's largest legal pot market," AP long dreaded in the marijuana industry came just days after California opened what is expected to be the world's largest legal pot market," AP reports from L.A. "The Trump administration announced ... that it was ending an Obama-era policy to tread lightly on enforcing U.S. marijuana laws." 
   
   announced ... that it was ending an Obama-era policy to tread lightly on enforcing U.S. marijuana laws." "The declaration renewed anxiety, confusion and uncertainty that has long shadowed the bright green leafy drug still forbidden under federal law but now legal in a majority of states as medicine and in a handful of those for recreational purposes." 
   
   anxiety, confusion and uncertainty that has long shadowed the bright green leafy drug still forbidden under federal law but now legal in a majority of states as medicine and in a handful of those for recreational purposes." Why it matters: "The action by Attorney General Jeff Sessions was not unexpected given his longtime opposition to pot, but comes at a heady time for the industry as retail pot sales rolled out New Year's Day in California." What's next: Citing states' rights, Sen. Cory Gardner (R-Colo.), chairman of the National Republican Senatorial Committee, said he found Sessions' announcement "extremely alarming," and said he was prepared to place a hold on Justice Department nominees." A DoJ source: "Cory Gardner can change federal law; the Department of Justice cannot." 
   
   8. "My personal challenge for 2018" Facebook screenshot Facebook CEO Mark Zuckerberg announced his 
   
   announced his 2018 personal challenge : "fixing" the platform he created so that "we'll end 2018 on a much better trajectory." Zuckerberg wrote that when he announced his first challenge in 2009, "the economy was in a deep recession and Facebook was not yet profitable. We needed to get serious about making sure Facebook had a sustainable business model. It was a serious year, and I wore a tie every day as a reminder." 
   
   that when he announced his first challenge in 2009, "the economy was in a deep recession and Facebook was not yet profitable. We needed to get serious about making sure Facebook had a sustainable business model. It was a serious year, and "Today feels a lot like that first year. The world feels anxious and divided, and Facebook has a lot of work to do — whether it's protecting our community from abuse and hate, defending against interference by nation states, or making sure that time spent on Facebook is time well spent." 
   
   a lot like that first year. and Facebook has a lot of work to do — whether it's protecting our community from abuse and hate, defending against interference by nation states, or making sure that time spent on Facebook is time well spent." What's next: The issues facing Facebook "touch on questions of history, civics, political philosophy, media, government, and of course technology. I'm looking forward to bringing groups of experts together to discuss and help work through these topics." Why it matters: Zuckerberg's post is the latest indication that Facebook leaders recognize that misuse of the platform during the 2016 election — including fake news, and infiltration by Russian manipulators — are no passing blip, and require fixes from the top. Facebook execs tell us they plan to change without waiting for legislation, and this is a sign of that. 
   
   tell us they plan to change without waiting for legislation, and this is a sign of that. Go deeper: See Zuckerberg's full post. For each of us: What's your singular personal challenge for 2018? If you have an interesting one, shoot me a note at mike@axios.com (or must reply to this email!), and I'll share your idea with other AMers. 
   
   9. New overnight: Sports talker Robert Kraft, owner and CEO of the New England Patriots, head coach Bill Belichick and Tom Brady celebrate a year ago at the AFC Championship Game in Foxboro, Mass. (Photo by Maddie Meyer/Getty Images) Power struggle at Foxboro: "For Kraft, Brady and Belichick, is this the beginning of the end?" by ESPN The Magazine senior writer Seth Wickersham: "[T]he three most powerful people in the franchise — [coach Bill] Belichick, [QB Tom] Brady and owner Robert Kraft — have had serious disagreements." 
   
   people in the franchise — [coach Bill] Belichick, [QB Tom] Brady and owner Robert Kraft — have had serious disagreements." "They differ on Brady's trainer, body coach and business partner Alex Guerrero; over the team's long-term plans at quarterback; over Belichick's bracing coaching style; and most of all, over who will be the last man standing." 
   
   on Brady's trainer, body coach and business partner Alex Guerrero; over the team's long-term plans at quarterback; over Belichick's bracing coaching style; and most of all, over who will be the last man standing." Why it matters: "Those interviewed describe a palpable sense in the building that this might be the last year together for this group." 
   
   "Those interviewed describe a palpable sense in the building that this might be the "Kraft, Brady and Belichick were supposed to meet in late December to clear the air, but that never happened. It probably won't until after the season. Those interviewed describe a lingering sadness around the team, as if coaches and staff know that the end might be near." 
   
   were supposed to meet in late December to clear the air, but that never happened. It probably won't until after the season. Those interviewed describe a lingering sadness around the team, as if coaches and staff know that A classic Brady moment ... In a legendary playoff game, the Snow Bowl in 2002 (the Tuck Rule Game), when the Patriots played the Raiders in the snow, Brady once recalled in an NFL Films interview that "he took the field for warm-ups wearing a sleeveless T-shirt in the thick snow. He was 24 years old, at the beginning of a career only he saw coming. He wanted to send a message to everyone watching that nobody was tougher, both mentally and physically, than this California kid." 
   
   In a legendary playoff game, the Snow Bowl in 2002 (the Tuck Rule Game), when the Patriots played the Raiders in the snow, Brady once recalled in an NFL Films interview that "he took the field for warm-ups wearing a sleeveless T-shirt in the thick snow. He was 24 years old, at the beginning of a career only he saw coming. He wanted to send a message to everyone watching that nobody was tougher, both mentally and physically, than this California kid." Worthy of your time. ||||| Sen. Bernie Sanders (I-VT) will release a proposal Wednesday afternoon to transition the United States to a single-payer health care system, one where a single government-run plan provides insurance coverage to all Americans. 
   
   The Sanders plan envisions a future in which all Americans have health coverage and pay nothing out of pocket when they visit the doctor. His plan, the Medicare for All Act, describes a benefit package that is more generous than what other single-payer countries, like Canada, currently offer their residents. 
   
   The Sanders plan goes into great detail about the type of coverage Americans would receive. But it provides no information on how it would finance such a generous health care system. Americans’ taxes would have to change to pay for this kind of proposal. But it’s impossible to tell who would pay significantly more for their coverage and who would pay less, and by how much. This is a crucial part of any health care plan, and in the Sanders proposal, it is notably absent. 
   
   So while the plan would certainly move the American uninsured rate from around 8.8 percent to nearly zero in theory, it’s impossible to tell what it would take to get there and what the bigger economic picture would look like if we did. 
   
   The Sanders bill includes an exceptionally generous benefit package 
   
   Sanders’s single-payer proposal would create a universal Medicare program that covers all American residents in one government-run health plan. 
   
   It would bar employers from offering separate plans that compete with this new, government-run option. It would sunset Medicare and Medicaid, transitioning their enrollees into the new universal plan. It would, however, allow two existing health systems to continue to operate as they do now: the Veterans Affairs health system and the Indian Health Services. 
   
   Those who do qualify for the new universal Medicare plan would get four years to transition into the new coverage. In the interim, they would have the option to buy into Medicare or another publicly run option that does not currently exist. 
   
   Eventually, though, they would all end up in the same plan, which includes an especially robust set of benefits. It would cover hospital visits, primary care, medical devices, lab services, maternity care, and prescription drugs as well as vision and dental benefits. 
   
   The plan is significantly more generous than the single-payer plans run by America’s peer countries. The Canadian health care system, for example, does not cover vision or dental care, prescription drugs, rehabilitative services, or home health services. Instead, two-thirds of Canadians take out private insurance policies to cover these benefits. The Netherlands has a similar set of benefits (it also excludes dental and vision care), as does Australia. 
   
   What’s more, the Sanders plan does not subject consumers to any out-of-pocket spending on health aside from prescriptions drugs. This means there would be no charge when you go to the doctor, no copayments when you visit the emergency room. All those services would be covered fully by the universal Medicare plan. 
   
   This too is out of line with international single-payer systems, which often require some payment for seeking most services. Taiwan’s single-payer system charges patients when they visit the doctor or the hospital (although it includes an exemption for low-income patients). In Australia, people pay 15 percent of the cost of their visit with any specialty doctor. 
   
   The Sanders plan is more generous than the plans Americans currently receive at work too. Most employer-sponsored plans last year had a deductible of more than $1,000. It is more generous than the current Medicare program, which covers Americans over 65 and has seniors pay 20 percent of their doctor visit costs even after they meet their deductibles. 
   
   Medicare, employer coverage, and these other countries show that nearly every insurance scheme we’re familiar with covers a smaller set of benefits with more out-of-pocket spending on the part of citizens. Private insurance plans often spring up to fill these gaps (in Canada, for example, vision and dental insurance is often sponsored by employers, much like in the United States). 
   
   The reason they went this way is clear: It’s cheaper to run a health plan with fewer benefits. The plan Sanders proposes has no analogue among the single-payer systems that currently exist. By covering a more comprehensive set of benefits and asking no cost sharing of enrollees, it is likely to cost the government significantly more than programs other countries have adopted. 
   
   Would Sanders’s health plan lower American health spending? It’s hard to tell. 
   
   One of Sanders’s main arguments in favor of his health care bill is that American health spending is out of control and single-payer would rein it in. 
   
   There are certainly policies in the Sanders plan that would reduce American health care spending. For one, moving all Americans on to one health plan would reduce the administrative waste in our health care system in the long run. 
   
   American doctors spend lots of money dealing with insurers because there are thousands of them, each negotiating their own rate with every hospital and doctor. An appendectomy, for example, can cost anywhere from $1,529 to $186,955, depending on how good of a deal an insurer can get from a hospital. 
   
   That doesn’t happen in a single-payer system like the one Sanders proposes. Instead of dealing with dozens of insurers that set hundreds of prices, doctors only need to send bills to the federal government. 
   
   One 2003 article in the New England Journal of Medicine estimates that the United States spends twice as much on administrative costs as Canada. A 2011 study in the journal Health Affairs estimates American doctors spend four times as much dealing with insurance companies compared with Canada. 
   
   A single-payer health plan would have the authority to set one price for each service; an appendectomy, for example, would no longer vary so wildly from one hospital to another. Instead, the Sanders plan envisions using current Medicare rates as the new standard price for medical services in the United States. 
   
   Medicare typically has lower prices than those charged by private insurance plans that cover Americans under 65. This suggests that switching to the Medicare fee schedule would be another policy change that would tug health spending downward. 
   
   But there are forces in the Sanders plan that encourage higher health spending too. Its robust benefit package with no cost sharing would likely lead to more doctor visits and hospital trips. As the classic RAND Health Insurance Experiment found, patients respond to lower cost sharing in health care by seeking more treatment. Some of that treatment is necessary, but other services provided are not. 
   
   And the Sanders bill would actually raise the prices currently paid by Medicaid, which covers about 50 million low-income Americans. Medicaid traditionally pays lower prices than Medicare and private insurance. If these patients were absorbed into the universal Medicare plan, their doctors would be paid more each time they were seen. 
   
   We haven’t seen a Congressional Budget Office score of the Sanders plan yet — and it’s hard to know how these countervailing forces (some pushing health spending up and others forcing it down) would interact with one another to change overall health costs. 
   
   The big question Sanders doesn’t answer: how do you pay for it? 
   
   The Sanders plan goes into great detail on what kind of coverage a universal plan ought to offer. But it does not do any work explaining how to pay for such a generous benefit package. 
   
   A Sanders spokesperson said over email the office would release a set of financing options later Wednesday afternoon. 
   
   “There’s nobody who has all of the answers,” Sanders told my colleague Jeff Stein when asked about the financing of his health plan. “Nobody has all the answers. What I can say is we are going to be listing a number of revenue-raising proposals, which will generate more than enough money to pay for what we want to do.” 
   
   Eventually though, somebody will need to have those answers — and they’re not easy to find. 
   
   Financing the health care system that Sanders envisions is an immense challenge. About half of the countries that attempt to build single-payer systems fail. That’s Harvard health economist William Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he is in Taiwan, Cyprus, or Vermont, the process is roughly the same: Meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it. 
   
   This is what happened when Sanders’s home state of Vermont attempted to create a single-payer plan in 2014. Much like Sanders, local legislators outlined a clear vision of the type of health plan they’d want to extend to all Vermonters. Their plan was arguably less ambitious; it did require patients to pay money when they went to the doctor. 
   
   But Vermont’s single-payer dream fell apart when the state figured out how much it would need to raise taxes to finance its new system. Vermont abandoned the government-run plan after finding it would need to increase payroll taxes by 11.5 percent and income tax by 9 percent. 
   
   It’s true — in Vermont and in the United States — that these increased taxes don’t necessarily mean overall health spending is rising. It’s entirely possible that health spending will go down as taxes go up, with Americans no longer spending billions on premiums for employer-sponsored coverage. 
   
   Single-payer systems change who pays for health care, often shifting more of the burden onto wealthier individuals to create a more progressive system. The proposed 9 percent income tax in Vermont, for example, would be far more expensive for the $100,000 worker than the $30,000 earner. 
   
   But who pays how much more is a key question this Sanders bill doesn’t answer. Until there is a version that does, we can’t know whether the health system the Vermont senator envisions could actually become reality. ||||| (CNN) When Sen. Bernie Sanders did this in 2013, he did it alone. 
   
   On Wednesday, nearly four years later, Sanders introduced a new "Medicare for all" health care bill with a third of the Senate Democratic caucus by his side. 
   
   Flanked at first by New York Sen. Kirsten Gillibrand and Connecticut Sen. Richard Blumenthal, Sanders called the costs of the current system "insane and unaffordable," promising that the average family would benefit financially under his plan "because you will no longer be writing checks to private insurance companies." 
   
   For those whose taxes would go up, he added, "that expense will be more than offset by the money are you are saving with the elimination of private insurance costs." 
   
   Sanders said he planned to take the bill on the road to "every state in the country and hear what the people have to say" for a roving national workshop. But the outreach came with a warning. He fired a shot across the bow of Republicans likely to oppose the bill, saying the GOP had "no credibility on the issue of health care." 
   
   "To my Republican colleagues, please don't lecture us on health care," Sanders roared to applause from the dozens of activists in the room. "In the last few months, you, the Republican Party have shown the American people what you stand for" by largely voting to dismantle Obamacare. 
   
   Taking her turn, Massachusetts Sen. Elizabeth Warren framed the push for single payer as the latest step in a long liberal project to expand access to medical care -- from Franklin Roosevelt's social security to Medicare and Medicaid under Lyndon Johnson and, most recently, Barack Obama's signature legislation. 
   
   "But we are here today to take another step," she said. "We will not back down in our protection of the Affordable Care Act, we will defend it at every turn, but we will go further -- we will go further and we will say that in this country, everyone gets the right to basic health care." 
   
   Before Sanders' remarks, supporters shared personal, often visceral accounts of doctors currently struggling to provide care and patients in need. An oncology nurse drew gasps in the room as she recounted the story of a cancer patient who could not afford to continuously empty the fluid building up in her lungs. The price of drainage bags, she said, was only covered in part by insurance, forcing the woman to ration her use. 
   
   The legislation unveiled on Wednesday afternoon in Washington arrived a little more than six weeks after the party's all-hands fight to preserve Obamacare secured a narrow reprieve on the Senate floor . Sanders' plan, though dead-on-arrival in a Republican-controlled Congress, offers a blueprint for fundamentally reshaping the American health care system by moving the country to a government-run, single-payer program. 
   
   Under Sanders' proposal, Americans would receive a "Universal Medicare card" that would be a ticket to comprehensive health care services, including hospital stays, doctor visits, substance abuse treatment, dental, vision and reproductive care -- including abortion. 
   
   However, consumers may have to pay up to $250 out-of-pocket for prescription drugs, with incentives to use generic medications. Sanders, who's been vocal about lowering drug prices, would allow the government to negotiate with pharmaceutical companies. 
   
   Long-term care, which Sanders had included in the version he unveiled during his presidential campaign last year, will not be covered. It will be addressed in separate legislation, an adviser to Sanders told CNN. 
   
   The bill calls for the elimination of premiums for private health insurance, deductibles and co-pays. However, most Americans and businesses will pay what Sanders says is a much smaller share of their income to fund the program. 
   
   While the new legislation has not yet been scored, the program Sanders pitched on the campaign trail came with an estimated annual price tag of nearly $1.4 trillion, to be paid for in part by a proposed new 2.2% income tax on all Americans, a 6.2% levy on employers and a further round of tax hikes on the wealthy. 
   
   California Sen. Kamala Harris made the business-friendly case for single-payer. (Or, as one leftist activist in the room grumbled afterward, "the neoliberal case.") 
   
   "Let's give the taxpayer of the United States a better return on their investment," she said. "Why? Because 'Medicare for all' stands for the proposition that all Americans from the day of birth, throughout their lives, will have access to health care." 
   
   The talk on Wednesday was broad, with little mention of the financial mechanics needed to propel such a massive program. But Sanders' plan does address one of the stickier questions facing such proposals: how to phase out the current system, which depends primarily on employer-sponsored private plans, without creating a disruption in care. 
   
   The answer, according to this new version of the bill, is to roll it out over a four-year transition period, a process Gillibrand and her office had a big hand in crafting. 
   
   The law would beef up Medicare -- adding dental, vision and hearing aid coverage -- in its first year, while reducing the eligibility age to 55. Children, up to age 18, would also be offered immediate access to the government-run plan. Over the next two years, the Medicare age would drop to 45, then 35 years old. By the fourth year, everyone would be eligible. 
   
   Despite the considerable legislative obstacles in its way, single-payer as a concept is gaining traction among the public. Some 53% of Americans support a national health care plan , according to a June poll by the Kaiser Family Foundation. That's up from 50% last year and from 40% between 1998 and 2000. 
   
   It is also notably increasing in popularity with some of the most ambitious Democratic officeholders -- a group of Senators possibly looking to run for the party's presidential nomination in 2020. 
   
   Harris was the first to announce plans to cosponsor the bill, followed by Warren. New Jersey Sen. Cory Booker and Gillibrand made their plans public on Monday and Tuesday. The names, some expected, others less so, rolled in right up to a few hours before the event, when New Hampshire Sen. Jeanne Shaheen announced her support. 
   
   Notable absences, however, included Senate Minority Leader Chuck Schumer of New York, Ohio Sen. Sherrod Brown, California Sen. Dianne Feinstein and the party's 2016 vice presidential nominee, Virginia Sen. Tim Kaine. Of the latter three, all up for reelection in 2018, only Brown is expected to face a serious Republican challenge. 
   
   Single-payer activists, mostly from the progressive grassroots movement that fueled Sanders' 2016 presidential campaign, are delighting in a sense of momentum after years stuck on the margins of the debate. 
   
   "This is an especially gratifying moment for the tens of thousands of nurses across the US who have dedicated years of effort to transform our health care system from an profiteering industry based on greed and suffering to patient need and healing," National Nurses United Executive Director RoseAnn DeMoro said in a statement. 
   
   She called the bill's introduction a "direct product of how Sen. Sanders made Medicare for all, and healthcare as a human right, such a signature issue of his campaign."
target: – Bernie Sanders rolled out his vision to overhaul the health care system on Wednesday, one in which everybody would get their insurance from the government through Medicare instead of through their jobs or a private insurer. Sanders calls it the Medicare for All Act of 2017, but you'll also hear phrases such as "single payer" and "universal health care" used to describe it. One key part missing: details on how to pay for it, though Sanders plans to release a separate paper on that, reports the Wall Street Journal. Coverage: The basics: Per CNN, everybody gets a "Universal Medicare card," which would be used to cover all health bills, from surgeries to dental care to substance abuse treatment. Co-payments would go away, and people would pay premiums based on their incomes, reports the AP. Private insurers would still exist, but for things such as elective plastic surgery or, sometimes, to act as middlemen between the government and hospitals or doctors. A 'right': Sanders makes his case in an op-ed in the New York Times. "Guaranteeing health care as a right is important to the American people not just from a moral and financial perspective; it also happens to be what the majority of the American people want." 'Single payer': David Leonhardt of the New York Times has a Q&A on the fundamentals, including the basic question of what the term "single payer" means. In short, it "describes a system in which only one entity—the government—pays medical bills. If all Americans had Medicare rather than insurance through their jobs, it would be a single-payer system." Vox says Sanders' system is far more generous than single-payer plans in Canada and elsewhere. The cost: This could cost hundreds of billions of dollars more per year, per the Journal. Details are yet to come, but Sanders envisions a progressive tax increase, with the wealthy paying more income, capital gains, and estate taxes, reports Newsweek. The senator says higher taxes for families would be offset by the fact that they no longer have to buy insurance. Still, in regard to single-payer systems, "no one—including Sanders—has truly reckoned with how to pay for whatever system they might support," writes Mike Allen at Axios. Litmus test? By all accounts, the chances of it passing a GOP-controlled Congress are precisely 0%. But it's turning into a political litmus test of sorts for Democrats, reports the Washington Post. Sanders has the support of 15 Democratic senators so far, including all of those seen as potential 2020 presidential candidates. Co-sponsors include Elizabeth Warren, Kirsten Gillibrand, Cory Booker, and Kamala Harris. But many prominent Democrats are not on board, at least yet, including Nancy Pelosi, Chuck Schumer, and those in tough re-election fights, reports Politico. The politics: No, this isn't going to pass, "but here's the big question," writes Perry Bacon Jr. at FiveThirtyEight. "Is it going to become one of the central goals of the Democratic Party and a defining feature of the campaign of whichever Democrat is the party's nominee in 2020?" As of now, this "seems very likely," as the Democratic party seems to be gravitating to the left. But Bacon lays out the political and policy reasons why Democrats might avoid "becoming the party of single payer." Relishing the fight: Republicans see a chance to pounce. "We welcome the Democrats' strategy of moving even further left," says Katie Martin, spokesperson for the Senate GOP's campaign organization, per the AP.