DETROIT — It looked just like a campaign launch, from the line winding around the Fellowship Chapel Church, to the tailgaters giving away hot dogs, to the 2,000 voters who eventually packed inside.
But when Sen. Bernie Sanders (I-Vt) and Rep. John Conyers Jr. (D-Mich.) arrived, there were no waving signs. They were there to kick off the push for universal health care, with legislation queued up for September, and no expectation that the Republican-controlled Congress would pass it.
“Every major country in the world, they’ve already got it,” said Conyers.
“More and more people agree with us,” said Sanders.
As Washington prepares for a month of spending deadlines, and as Republicans and business groups try to shift the conversation to tax reform, Sanders is trying to drive a discussion about single-payer health care — a debate that he admits would last for years before any legislative action.
The campaign will put the Senate’s only democratic socialist in a unique position. Republicans have already begun attacking Democrats over “government-run health care,” daring them to endorse Sanders’s plan. On the left, activists inspired by Sanders’s 2016 presidential bid intend to browbeat Democrats who don’t back Sanders’s and Conyers’s legislation.
In an interview after his three-state Midwestern tour, Sanders said he was formulating an “inside/outside strategy,” attracting as much support as possible from his colleagues while expecting most of them to recoil. It would be up to activists to make single-payer politically possible for the holdouts.
In the meantime, as the chair of the Senate Democrats’ political outreach, he would continue to support colleagues in tough races, even if they rejected his bill.
“Is this a litmus test? No, you have to look at where candidates are on many issues,” said Sanders. “But you’re seeing more and more movement toward ‘Medicare for All.’ When the people are saying we need health care for everyone, as more and more Americans come on board, it will become politically possible.”
Republicans, looking hungrily at a 2018 Senate map where 10 incumbent Democrats will compete in states won by Trump, were hoping for a litmus test. But in just two states, West Virginia and North Dakota, are incumbents being challenged by progressives in primaries. Neither challenger is being backed by Sanders.
Still, as Sanders wove through Indiana, Ohio and Michigan, local conservatives mocked those states’ Democratic senators, even those who didn’t appear with Sanders.
When Sanders stumped in Ohio’s Scioto County, one of the places that had seen a tight presidential race in 2012 but delivered a landslide for Donald Trump in 2016, Ohio Republican Party chair Jane Timken pointed out that Sen. Sherrod Brown (D-Ohio) had frequently supported the idea of single-payer health care. (Brown did not appear at the event, though former governor Ted Strickland sat in the front row.)
“The only place Bernie Sanders’ socialist sales pitch will be welcomed today is in Senator Sherrod Brown’s office,” said Timken in a statement. “Scioto County voters rejected socialized health care and the job destroying economic policies of Sanders and Brown last year by overwhelmingly electing President Trump.”
In Web ads, Republicans and the Congressional Leadership Fund super PAC spent July and August attacking vulnerable-seeming Democrats on single-payer, frequently using the image of Sanders or Sen. Elizabeth Warren (D-Mass.) to argue that Trump-state Democrats had become extremists.
Sanders, who chose his Midwest event sites carefully, sees Republicans getting over their skis. In national polling, he’s frequently viewed more favorably than either the president or the Democratic Party itself. Last week, in polls of the three Midwestern states won by Trump, NBC found Sanders’s favorable rating at 58 percent in Michigan, 53 percent in Wisconsin, and 51 percent in Pennsylvania. In each state, the president’s approval rating had tumbled below 40 percent.
On the merits of ‘Medicare for All’ itself, Sanders said that the “landscape had changed” as a result of the seven-month debate over repealing the Affordable Care Act: The concept of universal health care had grown more popular, while the market-based Republican replacements were undone, in large part, because of the unpopularity of reducing Medicaid rolls.
“People are saying ‘the ACA did some good things, and the Republicans wanted to throw 22 million people off of it,’” Sanders said. “That’s an absurd idea to most people.”
But single-payer was not going to start with clear partisan support. Sanders intends to release a single-payer bill in the Senate, a companion to Conyers’s House Resolution 676, in the weeks after Labor Day.
Sanders does not expect a majority of his Senate colleagues to endorse it, as a majority of House Democrats had in backing Conyers’s bill. And he admits it would take work, perhaps years of it, to reframe single-payer health care as an aggregate cost-saver, instead of an expensive entitlement in any debate.
“The pay-for is going to be a separate piece of legislation,” said Sanders. “It will not be radically different from the proposal we introduced during the presidential campaign. It will exempt lower income people from making any payments at all. But people in the average middle class family, when they recognize they don’t have to pay for private insurance anymore, are going to save tremendously.”
Meanwhile, Sanders’s rejection of the “litmus test” hinted at where Democrats, pressured by their base, would be allowed to go. Few of the most vulnerable 2018 Democrats are expected to get behind his bill, but progressive groups have talked increasingly about “Medicare for All” becoming a do-or-die position.
“Our view is that within the Democratic Party, this is fast-emerging as a litmus test,” said Ben Tulchin, the pollster for Sanders’s 2016 campaign, in an August interview with Politico.
Sanders, however, is allowing his colleagues plenty of room to maneuver — so long as they come out for expanding health insurance. He complimented Sen. Brian Schatz (D-Hawaii), who last week rolled out a proposal to allow anyone to buy into Medicaid if their states allowed it.
“Brian is doing good work,” said Sanders. “I think we need to have short-term solutions to the health-care crisis, while working toward Medicare for All. I would hope we could get some support for making more people eligible for Medicaid. We need to substantially lower the prices for prescription drugs. I’d favor a public option, right now, and we’re working on that in the [Health, Education, Labor, and Pensions] Committee.”
The midterms will be one test; the 2020 presidential race will be another. Sanders, who has not ruled out a second presidential bid, suggested that whatever happened in 2018, it would be difficult — if advocates kept working at it — for any 2020 Democrats to back down from single-payer.
“Could people run? Sure,” Sanders said. “Do I think they can win without supporting single-payer? I’m skeptical. Among the people who consider themselves progressive, who vote in the primaries, there’s clearly movement toward Medicare for All.”