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Illustration: Lazaro Gamio / Axios

Single payer isn't going anywhere — in either direction. It's not going to pass anytime soon, obviously. But after today, it's also not going away anytime soon.

Sen. Bernie Sanders will introduce his "Medicare for All" legislation today and, in addition to Sanders, four more of Democrats' top 2020 prospects — Sens. Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren — have already signed on as cosponsors.

The bottom line: Yes, this is a big deal. But if it's time to take single-payer seriously as a political concept, it's also time to start grappling with the policy.

  • Single-payer means different things to different people. But for so many powerful, viable Democrats to endorse just the conceptual idea of single-payer is still a huge political shift.
  • Even if some of them are only doing it because they feel like they have to, that's arguably a bigger change. It wasn't that long ago you had to say you opposed single-payer if you wanted to be taken seriously as a presidential candidate.

But here are the policy problems:

  • No one has a clear vision of what “single payer" actually means, and no one other than Sanders cares how Sanders's bill answers those questions.
  • The Democrats cosponsoring Sanders' bill will almost certainly treat it as a political proxy — a broad statement of support for a vaguely defined goal rather than a specific policy endorsement.

Where each Democrat ends up could be very different, and could stop far short of true single-payer. Even"Medicare for all" isn't true single-payer. Most Medicare beneficiaries buy private supplemental coverage to fill in gaps the government program doesn't cover. Its drug benefit is largely privately administered.

  • "Whether it's 'Medicare for All,' Medicare buy-in, Medicaid buy in, all-payer, utilizing Medicare as a negotiator — the constant theme will be policies that work constructively and aggressively to leverage the power of the federal government," said Chris Jennings, a veteran Democratic health care strategist.
  • No one — including Sanders — has truly reckoned with how to pay for whatever system they might support.

There's still political risk here.

  • Single-payer feels like it has a lot of momentum because so many potential presidential candidates are now supporting it. But Senate Democrats up for reelection next year in red states aren't signing on.
  • Even House Speaker Nancy Pelosi, who has said in the past that she'd love single payer but is also trying to win the House next year, declined to back Sanders' bill and said it's not a litmus test for Democrats.
  • Any form of single payer would require enormous tax increases, and as long as Democrats are in that ballpark, the details are all the same to Republican campaign committees.

The bill Sanders is introducing today doesn't just have a long way to go before becoming law. It's not even really on that road. It also has a long way to go before single-payer starts to represent a specific vision, and one that down-ballot Democrats want to entertain. But having Booker, Harris, Gilibrand and Warren all on board is a step in that direction.

  • "As long as the different approaches recognize that they have a common denominator, I think it can be quite effective," Jennings said.

Go deeper

Ben Geman, author of Generate
12 mins ago - Energy & Environment

Japan vows deeper emissions cuts ahead of White House summit

Japanese Prime Minister Yoshihide Suga. Photo: Carl Court/Getty Images

Japan on Thursday said it will seek to cut greenhouse gas emissions by 46% below 2013 levels by 2030, per the AP and other outlets.

Why it matters: The country is the world's fifth-largest largest carbon dioxide emitter and a major consumer of coal, oil and natural gas.

Biden pledges to cut greenhouse gas emissions by up to 52% by 2030

U.S. President Joe Biden seen in the Oval Office on April 15. (Photo by Doug Mills-Pool/Getty Images)

The Biden administration is moving to address global warming by setting a new, economy-wide greenhouse gas emissions reduction target of 50% to 52% below 2005 levels by 2030.

Why it matters: The new, non-binding target is about twice as ambitious as the previous U.S. target of a 26% to 28% cut by 2025, which was set during the Obama administration. White House officials described the goal as ambitious but achievable during a call with reporters Tuesday night.

Exclusive: Chauvin trial prosecution worked with strategic communications firm

People gather at the intersection of 38th Street and Chicago Avenue to celebrate the guilty verdict in the Derek Chauvin trial on April 20, 2021 in Minneapolis, Minnesota. Photo: Brandon Bell/Getty Images

For most of the past year, a strategic communications firm with deep Washington ties has played an integral role for the prosecution in the State of Minnesota v. Derek Chauvin — operating without pay and so under-the-radar that most of its own staff had no idea.

The big picture: Finsbury Glover Hering — formerly known as the Glover Park Group — has been conducting media monitoring and analysis as part of legal team special prosecutor Neal Katyal's vision for a three-pronged "modern appeal/trial strategy."