I have sat in the room for every congressional hearing on Medicare for All since Congress held its first one in 2019. I am one of very few people, and even fewer healthcare providers, who can say that. I was there at the beginning, alongside representatives from organizations including National Nurses United and Physicians for a National Health Program, invited by Congresswoman Pramila Jayapal to witness and advocate for that historic moment. That first hearing centered on H.R. 1384, the Medicare for All Act of 2019, introduced by Jayapal and championed alongside Congresswoman Debbie Dingell. It was the first time in history that Congress held a hearing specifically on Medicare for All legislation.

I watched Ady Barkan testify through a computerized voice as ALS took away his ability to speak on his own, telling Congress what it costs a family to fight a terminal illness in a country that treats healthcare as a commodity. Then-House Speaker Nancy Pelosi (D-Calif.) appeared at the start of the hearing, a sign of how significant the moment was even to Democratic leaders who were not prepared to embrace the policy. Outside, advocates and reporters crowded the hallways because the room could not hold everyone who wanted to witness what was happening.

That room does not exist anymore. From the unique vantage point of someone who has been present at every congressional hearing on Medicare for All, the shift is impossible to miss.

Employers are projected to face another 9.5% increase in healthcare costs in 2027, pushing average employer-sponsored healthcare costs above $19,000 per employee and marking a fourth consecutive year of near-double-digit increases. Employees are projected to spend about $5,300 themselves in 2026 through payroll contributions and out-of-pocket costs, up 7.9% from the year before.

From where I have sat through every congressional Medicare for All hearing since 2019, the most important change is not that opposition has disappeared. It has not. It is that the old political assumptions no longer fit the evidence.

At some point, the status quo becomes the disruption. A new Yale-led preprint estimates that a national single-payer system modeled on the Medicare for All Act could reduce annual health spending by $1.04 trillion, nearly 20%, while averting roughly 114,000 deaths each year.

Washington Is Underestimating the Support

A national Data for Progress survey found 65% of voters support a Medicare for All system, including 78% of Democrats, 71% of independents, and 49% of Republicans. After voters heard competing arguments both for and against the policy, 58% still supported it. Two-thirds of voters say the government does too little to help Americans afford healthcare, while nearly two-thirds hold unfavorable views of private insurers and pharmaceutical companies.

It is increasingly difficult to describe a policy with numbers like these as politically fringe.

Democrats Are Behind Their Own Voters

For years, Democratic leaders treated Medicare for All as something the party's progressive wing might demand but broader electorates would punish. Sen. Bernie Sanders (I-Vt.) changed that conversation more than perhaps any other national political figure. He made Medicare for All a defining issue in two presidential campaigns and introduced the Senate Medicare for All Act.

One image from the 2020........

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