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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

12 mins ago - World

Army to award Purple Hearts to troops injured in Iran missile attack

Damage at Ain al-Asad military airbase housing U.S. and other foreign troops in the western Iraqi province of Anbar in January 2020. Photo: Ayman Henna/AFP via Getty Images

The Army has approved 39 more Purple Hearts for U.S. soldiers wounded in an Iranian military ballistic missile attack on an Iraq base in January 2020, the Army Times first reported Wednesday.

Why it matters: Most of these soldiers sustained brain injuries, per the Army Times. Then-President Trump dismissed their injuries at the time as "headaches" and "not very serious," sparking backlash from some veterans groups.

Scoop: U.S. begins denying Afghan immigrants

Afghan refugees on a bus bound for temporary housing after arriving in Greece. Photo: Byron Smith/Getty Images

The Biden administration has begun issuing denials to Afghans seeking to emigrate to the United States through the humanitarian parole process, after a system that typically processes 2,000 applications annually has been flooded with more than 30,000.

Why it matters: Afghans face steeper odds and longer processes for escaping to the U.S., despite the earlier sweeping efforts by the Biden administration to assist its allies. Immigration lawyers and advocacy groups say the government has set untenable barriers to a safe haven in the U.S.

3 hours ago - Politics & Policy

Dems invoke Robert Byrd to sell Manchin on Senate rules changes

Photo illustration: Shoshana Gordon/Axios. Photos: Diana Walker, Chip Somodevilla/Getty Images

A small group of Senate Democrats is privately invoking the legacy of late West Virginia Sen. Robert Byrd in an effort to sway Sen. Joe Manchin (D-W.Va.) to support their plans to change the chamber's rules, Axios has learned.

Why it matters: Manchin — who holds Byrd's Senate seat — has often referenced his predecessor's strong moral conviction and insistence on preserving the Senate as an institution, as justification for some of his tough positions.