Don Berwick is making a vital point about the need for progressives to expand the discussion about healthcare reform.

Democratic and Republican strategists, and the candidates who let campaign consultants frame their range of opinion, are still engaging in picayune debates about the strengths and weaknesses of the Affordable Care Act.

But Berwick, who for seventeen months headed the Medicare and Medicaid programs under President Obama, isn’t getting lost in the political weeds. He’s blazing a trail in the direction of what ultimately must be done—pushing at the constraints of the conversation and offering an illustration of why it is so important for progressives to get specific about the need for a “Medicare for All” fix.

Mounting an admittedly uphill campaign for the Democratic nomination for governor of Massachusetts, Berwick says, “I want us to be the first state in the nation to adopt single-payer health care—Medicare for All. With that one change, we can improve care and reduce costs for families and businesses. We can free up resources that will add tens of thousands of jobs all over Massachusetts. Single-payer health care— let’s lead.”

Berwick does not raise this issue casually. A Harvard Medical School graduate who practiced medicine serving low-income families before founding the nonprofit Institute for Healthcare Improvement, advised the World Health Organization and was so well regarded for his advice and counsel on improving Britain’s healthcare system that he was knighted by Queen Elizabeth II.

But being one of the best thinkers and doers in the area of healthcare reform does not always bring rewards. During his tenure as administrator of the Centers for Medicare and Medicaid Services, Berwick was a key player in implementing some of the best components of the Affordable Care Act, including initiatives “ensuring that young people can stay on their parents’ health plans until the age of 26, kids with preexisting conditions can no longer be denied the care they need, and insurance companies are subjected to new levels of transparency.”

Yet, as Berwick’s campaign now notes, “The toxic politics of Washington cut short Don’s time there. Right-wing pundits attacked his commitment to equality and health care for all. Glenn Beck labeled him the ‘second most dangerous man in America.’ Senate Republicans vowed to filibuster his confirmation. In the face of the same Republicans who blocked Elizabeth Warren’s confirmation to head the Consumer Financial Protection Bureau, Don was forced to step aside after only seventeen months leading Medicaid and Medicare.”

The experience did not sour Berwick on the fight for healthcare reform.

But it did cause him to refocus his considerable energies.

The physician returned to his home state of Massachusetts and began preparing for a gubernatorial run in which he has argued that the states can and must lead on real healthcare reform.

To that end, he says, he wants to build on the leadership role Massachusetts has taken on reform to make Medicare for All a reality.

“I know from my first-hand experience in Washington guiding the early implementation of the Affordable Care Act that all eyes in the nation are on Massachusetts. Champions of real health care reform are crossing their fingers for us to succeed; opponents are hoping for us to fail. It is crucial that we lead, and show the rest of the nation that treating health care as a right, not a privilege, is sensible and successful public policy,” explains Berwick in a statement on his website.

It is time to find a way to get to yes on a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone—patients, families, doctors, and employers. On day one, I will appoint a multi-stakeholder Single Payer Advisory Panel to investigate and report back within six months on how Massachusetts moves to a single payer health insurance system like Medicare for all.

Massachusetts is not the only state where single-payer healthcare reform is being placed in the agenda. In Vermont, Governor Peter Shumlin and his legislative allies have made significant progress on the issue. And they are not alone.

Last month’s “Organizing for Healthcare Justice in the Age of Obamacare” strategy conference in Oakland, California, brought together Labor Campaign for Single Payer, Healthcare NOW! and the One Payer States group, as well as members of Physicians for a National Health Program and leading figures in National Nurses United, the California Nurses Association, the International Longshore and Warehouse Union and other labor groups. At the conference, much of the discussion was about state-based initiatives in Vermont, California, Minnesota, Oregon, Washington and other regions of the country.

In Massachusetts, Berwick says the work that has already been done in the state to extend access to health care creates an circumstance for developing a single-payer system. His arguments are strong in this regard. But it will take leadership to take the next step, which is why Berwick entered the gubernatorial race.

As next week’s primary approaches, he’s trailing two primary foes, Massachusetts Attorney General Martha Coakley and Massachusetts Treasurer Steven Grossman, both of whom have more resources and party connections. While his poll numbers have improved some as the September 9 primary approaches, Berwick is behind. Yet, if the measure of a campaign is the extent to which it shifts the discourse, Berwick’s run has already been a success: He’s at the table, as a candidate who is getting a serious hearing, participating in debates and in many senses framing the discourse.

After a June debate, an analysis for WBUR radio noted that Berwick “seems to be shifting the conversation, at least at this early stage, further to the left.”

In particular, explained the WBUR report, “Berwick seems to be adjusting the conversation… on the issue of a single-payer health care system.”

The other candidates are still more cautious on the issue. But Grossman is now saying that he wants to lead a “conversation” on single-payer—arguing, “You’ve got to build a consensus in our society around any dramatic societal change.” And while Coakley says “We’re not ready to go to single-payer yet,” she adds, “I don’t rule it out ever.”

But as the Massacusetts race steers toward a close, Boston Globe columnist Alan Wirzbicki writes: “This lackluster Democratic primary wouldn’t have been the same without [Berwick]. The only doctor in the race has added some needed fiber to the Democratic diet during this year’s gubernatorial campaign. His single-payer health proposal has forced his opponents to engage in a substantive discussion of health care costs…”