Today, Senator Bernie Sanders, Representative Pramila Jayapal, and Representative Debbie Dingell introduced the Medicare for All Act in the Senate and House. They are part of a long tradition.

For nearly a century, elected officials, pushed by progressive reformers, have tried to guarantee the right to health care in America. They came close to success a few times: during the New Deal, when health insurance was initially part of the proposal for Social Security; in the aftermath of World War II, under President Harry Truman, who made a national health plan his top domestic priority; between 1970 and ’74, when even President Richard Nixon was open to compromise on a plan that would ensure universal health insurance coverage, but well-intentioned congressional Democrats held out for a single-payer plan and ended up with nothing; and in 2009–10 when we were a few votes short in the Senate of winning a public option as part of the Affordable Care Act.

The most recent push to transform our cruel, ineffective, and wasteful health care system has been led by Senator Bernie Sanders, especially through his 2016 presidential campaign, when he helped push the idea of “Medicare for All” into mainstream political discourse. Medicare for All is a proposal for a federal universal health coverage program that would expand the benefits under the current Medicare system to include dental, vision, hearing, and long-term care, and guarantee quality health care to all Americans with no premiums, co-pays, or deductibles.

By 2019, Medicare for All had gained significant momentum Democratic circles—Sanders’s early front-runner status forced every Democratic candidate to outline plans that would, in one way or another, cover everyone in the country. The House of Representatives announced that it would hold its first-ever hearing on the Medicare for All Act. I texted Speaker Nancy Pelosi and asked if I could testify, and a week later I was the first witness in the overflowing Rules Committee room. I spoke through my computer; paralyzed by ALS at age 35, I embodied the reality that we all will need health care, no matter how lucky and privileged we feel.

“Our time on this earth is the most precious resource we have,” I said then. “A Medicare for All system will save all of us tremendous time. For doctors and nurses and providers, it will mean more time giving high quality care. And for patients and our families, it will mean less time dealing with a broken health care system and more time doing the things we love, together.”

As the Democratic presidential primary heated up, my organization, Be A Hero, partnered with the National Nurses Union to orchestrate a video series in which I interviewed six of the leading candidates, about the problems that ail our health care system and their visions for curing them. After he secured the nomination, Joe Biden agreed to sit down with me, and although we didn’t agree on everything—he doesn’t support Medicare for All—we agreed on enough that he invited me to speak about health care during the 2020 Democratic National Convention.

I had become a prominent champion for universal health care, particularly for strengthening and expanding Medicare. But I am now embarrassed to admit that I actually didn’t understand the massive changes that had been happening to the Medicare system. For more than two decades, health insurance corporations have been privatizing our cherished Medicare program. Now, I’m worried that once they have it we may never get it back.

About 25 years ago, Congress created Medicare Advantage—a program that allows private insurance companies to offer Medicare coverage and to be paid by the federal government for each person that they insure. And this month, we hit a critical threshold with more than 50 percent of all people on Medicare enrolled in one of these private plans. The Medicare Advantage program was created with the promise that the private sector could reduce costs by better managing care. But, as The New York Times reported in October—which is when I finally understood the scale and gravity of this problem—the hunger of health insurance corporations for profits that these plans supply has been insatiable. By abusing the system, including by making patients look sicker than they actually are, companies offering Medicare Advantage plans are being overpaid by taxpayers by at least $23 billion every year. The program is more costly than traditional Medicare, not more efficient.

We are talking about huge sums of money. The government pays insurance companies $400 billion every year, which is half the size of our military budget. Medicare Advantage is such good business that Humana, the country’s third-largest health insurance provider, announced recently that it is getting out of the employer-provided insurance business so that it can focus on growing its Medicare Advantage market.

But the profit being extracted at taxpayers expense is not just wasteful, it’s also deadly. Numerous reports have exposed that customers on these plans frequently face improper claims and prior authorization denials. Many people find themselves paying out of network costs, because the plans do not have sufficient in-network providers. And recent reporting exposed that these plans use artificial intelligence algorithms to deny people care, as opposed to having medical doctors reviewing claims individually as the law requires. These problems will only be exacerbated as the Medicare Advantage enrollees age and people’s health care needs increase.

This takeover of Medicare is restructuring health care in America in terrifying ways. Health insurance companies and private-equity firms are buying up primary care as fast as they can and extracting profit however they can. This corporatization undermines the public provision of health care—the very cornerstone of Medicare for All—as an idea and in practice.

Because there is so much money up for grabs, you can expect a big fight for what the future holds. Over the past few months, we’ve seen health-insurance companies spend tens of millions of dollars to push back even the smallest indication that someone might limit their gorging at the public trough.

As more people enroll in Medicare Advantage, and fewer in traditional Medicare, there may be less political will to improve traditional Medicare by adding vision, dental, and hearing coverage, and also less political will to rein in the abuse and profiteering of the Medicare Advantage plans. Left to them, the future of health care in this country might in fact be Medicare Advantage for All.

But the politics of this issue are shifting rapidly. Thanks in part to the Times reporting, Democrats in Congress are rethinking their support for Medicare Advantage.

Every year, the insurance industry gets its allies in Congress to send a letter to the White House, urging high payments and no new meddlesome regulation. It is an important flexing of political muscle: Last year, the letter from the House had more than 300 signatures. But this year, progressive advocates led by Social Security Works organized a decline-to-sign campaign. Representative Earl Blumenauer (D-Ore.), who had once been a lead author of the letter, started educating his colleagues about the problems with Medicare Advantage. As a result, the insurance industry did not even circulate the letter in the House, because it knew it would get far fewer signatures. As more and more people speak out about the denials and delays of care and the abuse and fraud in the system, our elected leaders are taking notice and beginning to talk about protecting Medicare from the corporate greed that is trying to devour it.

There is a better way. Bound up in the Medicare for All legislation are the hopes and dreams of the majority of Americans—people who want to know that their loved ones will get good care if they are diagnosed with cancer, that they won’t go bankrupt paying for a hip replacement, and that they can be cared for at home alongside the people they love. These ideas are rational, humane, and wildly popular. American voters from across the political spectrum support Medicare and Medicare for All—guaranteed health care for all, without co-pays, deductibles, medical debt, or GoFundMe.

Generations of activists and leaders have pursued this same vision. But to get there, we will need to stop the corporate takeover of Medicare.

Over a year ago the Biden administration endorsed the idea that there should be enough Covid-19 vaccines for everyone in the world and that patents and international trade agreements should not be allowed to prevent that goal. But the administration has not taken the decisive leadership position to achieve it, and those barriers continue to block access to the vaccines for billions of people.

The announcement came after public health advocates urged Biden to honor his 2020 campaign promise to me that if the United States were to discover a vaccine, he would ensure that no patents stand in the way of other countries’ and companies’ mass-producing it. This time last year, I made a public appeal to Biden in The Nation to vaccinate the world. Since Biden’s pledge, little progress has been made to guarantee that people everywhere can get vaccinated, and thousands of people are still dying preventable deaths every day from the coronavirus.

Recently, on behalf of Oxfam and other shareholders, World Health Organization director Tedros Adhanom Ghebreyesus and I introduced resolutions at the Pfizer and Moderna shareholder meetings to study the feasibility of sharing vaccine technology with other manufacturers to ramp up production around the world. Shareholders voted down those resolutions. Without the threat of losing their monopolies, pharmaceutical companies have little incentive to make the morally right decision.

Pfizer and Moderna are not the heroes they make themselves out to be. The two companies received billions of dollars in public taxpayer funding to develop their vaccines. In fact, the public completely funded Moderna’s vaccine project. Their innovations were made possible by US taxpayer money and contributions from the international scientific community. Instead of sharing the technology to boost global manufacturing, Pfizer and Moderna have maintained a monopoly on an innovation that all of us helped to develop. Pfizer and Moderna cannot produce enough doses on their own to vaccinate the world. By upholding their monopoly, they allow billions of people to remain unvaccinated.

While 80 percent of people in high- and upper-middle-income countries have received at least one dose of a Covid-19 vaccine, only 16 percent of people in low-income countries have been able to secure the same protections. And yet, as of February, Pfizer allocated just 1 percent of its vaccine supply to low-income countries, and Moderna allocated even less. Meanwhile, as of March, Pfizer anticipates $32 billion in vaccine sales for 2022 and Moderna expects $19 billion. Pfizer and Moderna are complicit in exacerbating vaccine inequity in the name of profit.

On May 12, the United States will cohost a global summit for the purpose of “bringing solutions to vaccinate the world, save lives now, and build better health security—for everyone, everywhere.” But we are failing to heed our own exhortations. The US federal government has already stopped paying for treatments and vaccines for many people in this country, let alone others. Congress must pass Covid-19 supplemental funding now to protect people in America and throughout the world against the virus. Biden must also put diplomatic muscle behind his commitment at the global summit and convince the European Union and other world leaders to secure an intellectual-property waiver at the World Trade Organization that includes vaccines, testing, and treatment.

As one of the biggest beneficiaries of Big Pharma’s vaccine supply, we in the United States have a moral obligation to help vaccinate the rest of the world. The United States has the opportunity to lead the charge to waive intellectual property rights so that other countries can produce vaccines and protect their citizens.

We urgently need diversified, global manufacturing to provide equitable access to vaccines, save lives, reduce the risk of variants, and kick-start economic recovery. Making sure that everyone can get vaccinated is our best chance at ending the pandemic for all.

Last summer, President Joe Biden made a promise to me and to the American people.

While interviewing then-candidate Biden, I asked, “If the US discovers a vaccine first, will you commit to sharing that technology with other countries? And will you ensure there are no patents to stand in the way of other countries and companies’ mass-producing those lifesaving vaccines?” In response, Biden did not hesitate, equivocate, or mince his words. “Absolutely, positively. This is the only humane thing in the world to do,” Biden answered. He went on, concluding, “So, the answer is yes, yes, yes, yes. And it’s not only a good thing to do, it’s overwhelmingly in our interest to do it, as well. Overwhelmingly.”

Ten months after that interview, American innovation has delivered health and safety to the people of this country, and now Biden has the opportunity to reverse the course set by Donald Trump and steer the global community down a more just and humane path. Biden can make good on his pledge and help protect billions of people around the world from this deadly virus.

The fight against the pandemic is far from over, which is why Biden has such a great capacity to make a difference. Thousands of people are dying of Covid-19 each day in India, where medicine, oxygen, and ventilators have run short. And fatalities from the virus are higher than ever in Turkey, Iran, and Brazil. If we do not help vaccinate the world, vaccine resistant variants will likely come roaring back into the United States. So, as Biden correctly told me, it is in our own interest to lift vaccine protections. But it is also a moral imperative. The dreams of people in other countries are no less real than ours. Their love is no less strong. Their lives are no less worthy.

On Wednesday, Biden faces a critical juncture. That day, May 5, governments from around the globe will gather at the World Trade Organization. They will ask America to waive the rules that are blocking them from making enough vaccines to protect their people. The rules in question are governed by TRIPS—the WTO Agreement on Trade Related Aspects of Intellectual Property Rights. TRIPS requires governments to guarantee corporations’ patents and other intellectual property rights, including monopoly control over the production of vaccines and other medicines.

Because of these restrictions, not enough doses of the vaccine are being manufactured, despite the incredible industrial capacity of countries like India. This pharma-created shortage will result in the deaths of millions more people from Covid-19. A waiver would loosen corporations’ grip and allow countries and companies around the world to increase supply of the vaccine and treatments. A waiver would save lives.

As with too many global humanitarian crises, past is prologue. While a student at Yale Law School in 2008, years before I was diagnosed with and paralyzed by ALS, I was part of a student group fighting to improve access to essential medicines in poor countries around the world. The impetus for the group’s formation was the HIV/AIDS epidemic that in the 1990s was spreading rapidly through sub-Saharan Africa. Scientists at Yale developed an early AIDS treatment, the anti-retroviral drug called stavudine, but that the university later sold the patent to the multinational pharma corporation Bristol Myers Squibb. BMS in turn charged exorbitant prices for the medicine, leaving it out of reach for many millions of patients in low- and middle-income countries.

Students lobbied along with humanitarian organizations and successfully forced BMS to agree not to enforce their patent in South Africa. It was a monumental victory. By allowing generic companies to manufacture stavudine and other crucial therapies, it led to a 95 percent reduction in the price of AIDS medicine in Africa.

Now, once again, corporate greed is excluding countless people in poorer countries from access to a lifesaving solution. Pharmaceutical corporations received billions of dollars in public, taxpayer funding from Operation Warp Speed, and relied on the scientific research and innovation of people from around the world—from Uğur Şahin and Özlem Türeci, Turkish immigrants to Germany who developed the Pfizer formula, to Katalin Kariko, a Hungarian immigrant to the United States whose decades-long research into mRNA laid the foundation for both the Pfizer and NIH-Moderna shots. These people do not work to make billions of dollars. They work to save lives. The vaccine came from the best of humanity, and it must return to the world with the same intention, with access for all.

For those in our nation’s capital, there will be a rally in front of the White House Wednesday calling on the president to sign the waiver. Join if you can. The rest of us can call and write our lawmakers. We must all raise our voices. Past battles, including for access to the HIV/AIDS medicine, prove we can win.

Having ALS, a terminal illness, has made it clear to me what is controllable in this life and what is not. Diseases and illness will arise. They are an inevitable part of being mortal. But the ability to provide access to a vaccine once it is developed is within our power, people power. Access is a deliberate, human choice.

If any American leader of our lifetime has understood the value of a single life, and the deep pain of loss, it is Biden. But he also knows the beauty of salvation and the joy life can bring. In the marrow of his bones, I know Biden understands that the international laws barring vaccine access are wrong. I hope he carries his humanity with him on Wednesday. I hope Biden answers the world’s plea.

Within weeks, President Donald Trump is expected to announce a short list of promising Covid-19 vaccine candidates. As part of its Operation Warp Speed program, the Trump administration has given Big Pharma billions of dollars to expedite vaccine development, but provided little assurance that corporations will not profiteer. This raises a crucial question: If we get a safe and effective vaccine, will everyone be able to afford it?

The idea that some people would not receive a vaccine was once unthinkable. In a now legendary story, Jonas Salk developed the polio vaccine in 1955—and then gave it away for free. An interviewer once asked Salk who owned the patent for his polio vaccine. He responded, “Well, the people, I would say. There is no patent.” Salk was incredulous. “Could you patent the sun?”

Since then, pharmaceutical corporations have patented the medical equivalent of the moon and the stars. Patent monopolies have fueled the current drug pricing crisis, and they may block access to any future Covid-19 vaccine.

Consider the case of Moderna, the biotechnology company developing a short-listed vaccine with the National Institutes of Health. Moderna brags about its “broad and deep patent estate” on its website. The company has been granted over a hundred patent monopolies globally. If its vaccine proves safe and effective, Moderna’s monopolies will allow the corporation to set an exorbitant price. Monopolies will also allow Moderna to block other manufacturers from supplying the vaccine. It could throttle supply. The decision would rest with Stéphane Bancel, the CEO of Moderna.

Will Bancel be a hero like Salk? Salk refused a monopoly and trained scientists around the world to shore up supply. Bancel, on the other hand, has watched as Wall Street investors pumped his corporation’s stock price and made him a billionaire. Bancel has vaguely pledged to set a price in line with other respiratory vaccines—which cost up to $800—and flatly said, “We won’t have enough supply at the global level.” Despite this, Bancel has refused to relinquish his corporation’s monopolies.

The public should get a say. Like Salk, Bancel has benefited greatly from public dollars. His corporation received millions in funding as early as 2013 to help develop its new way of making vaccines. Federal scientists helped design the new Covid-19 vaccine and are now running the critical human tests. The government also just gave $483 million to scale manufacturing. The public is paying at every stage for this potential vaccine—and so many others. All five candidates Trump is expected to short-list have benefited from public funding.

Fortunately, we do not have to wait for Big Pharma to find it in its heart to be benevolent. We can force executives to be like Salk. The US government has the authority, under existing law, to break patent monopolies. In exchange for a modest royalty, the government can and should allow any manufacturer to produce promising Covid-19 medicines. The government threatened to use the approach to lower prices for a critical antibiotic when letters containing anthrax spores were sent to media outlets and the offices of Democratic Senators Tom Daschle and Patrick Leahy in 2001. The government should also require companies to share know-how, and ramp up public production for promising medicines. All contracts should safeguard affordability and availability for all.

The pharmaceutical industry’s principal objection to this approach would be its potential impact on innovation. We understand the need for medical innovation more than most. One of us was diagnosed at age 32 with ALS, a debilitating disease with a life expectancy of three to four years after diagnosis. The industry claims that without extravagant rewards, there would be no extravagant effort. But that story ignores just how deeply corporations like Moderna rely on public science. The National Institutes of Health alone spends $41 billion annually advancing medical research. Congress has appropriated billions more for Covid-19 work. Yet the corporations who benefit from this investment will be under no obligation to act in the public interest.

When Salk developed the polio vaccine, President Dwight Eisenhower said he was a “benefactor to mankind.” His work was “in the highest tradition of selfless and dedicated medical research.” Salk taught us that vaccines belong to the people.

It is time we claim them as ours.

Dear Speaker Pelosi,

I am sitting perfectly still in bed now, late at night, writing to you with just the darting of my pupils. The only noise is the rhythmic pulsing of my ventilator, pushing air into and out of my lungs. Keeping me alive.

As I write this, I feel humble, fearful, and compelled. Humble because you have incomparably more information and experience than I do about this legislative struggle—about any legislative struggle. Fearful, because I have looked at the graphs and read the stories from Italy; because you and I and my father in New York City are all at high risk; because I see the economy collapsing all around us, and I know how much immense pain it will cause.

And therefore I feel compelled to share my unsolicited opinion, my unsolicited plea. I fear that—because of the president’s selfish, malevolent incompetence—we will soon experience hundreds of thousands of American deaths, including perhaps mine or yours, and a great depression.

This momentous challenge demands a proportionate response, and you are in a position of power now. The Republicans need your cooperation. They must grapple with what you pass. Mitch McConnell cannot simply file it away, like he has so often in the past. This moment, this bill, this is your chance to save the American economy and millions of families from misery. This is your opportunity, our opportunity, to begin to build a more equitable America. I urge you to embrace the bold solutions being put forward by Chairwoman Maxine Waters and the Progressive Caucus. The American people deserve all the help we can get.

Of the many crucial interventions that are needed, I want to appeal to you about one, in particular: Ensuring that all taxpayers, including the undocumented who pay taxes with Individual Taxpayer Identification Numbers rather than Social Security numbers, receive direct cash support. Undocumented immigrant workers carry enormous weight in our society, and receive so little in return. They are helping us all survive during this shutdown, delivering food, working in warehouses, and providing health services. And the economic crisis is especially fierce in the hospitality industry in which so many of them work.

For years, Republicans have blocked immigrants from a path to citizenship and stability. Now, in this moment of crisis, I plead with you to put the least among us first. Prioritize their needs in your negotiations.

The world is so unpredictable. And yet I am confident in saying this: The decisions Congress makes in these days and weeks will be studied for generations. I know that you and your caucus can rise to the occasion. You can be our saviors.

In solidarity, with gratitude,

Ady

I have spent my entire career at the messy and vital intersection of movement-building, electoral politics, and governance. And for the past three years, I’ve done that work under the debilitating weight of ALS, a deadly neurological illness that’s robbed me of my ability to do almost all the things that most people take for granted: hug my son, go for a walk with my newborn daughter, or speak to my wife. I was diagnosed three weeks before the 2016 presidential election, and I vividly remember wondering, on that tragic November night, whether I was going to die under President Donald Trump.

Whom would I like to see replace him? Of the hundreds of elected officials, activists, and policy wonks I have worked with over the past two decades, Elizabeth Warren is the individual who I believe would make the best president. I believe that she, more than any other person in America, has the skills, the temperament, and the knowledge to lead us toward a more just and equitable future.

Please keep reading, especially if, like me, you’re an admirer of Bernie Sanders. Because I have no intention to diminish his incredible work building our progressive movement or the ways in which his historic campaigns for president have shifted American political discourse. This is, rather, a declaration of how I plan to vote in the California primary, and why.

I believe in Warren because during her whole career, she has fought to put economic and political power in the hands of working families. I’ve seen up close how she confronts a problem: She listens to the people most affected, does her homework, and then comes up with a plan. A brilliant, workable plan.

I’ve worked with Warren since before I was sick. She was a key partner for the Fed Up campaign, an effort I led to demand that the Federal Reserve use monetary policy as a vehicle for good, instead of as a handout to Goldman Sachs. And here are the characteristics of hers that make me believe she would be the best president in modern history:

1. Moral clarity. Warren understands that the central challenge of our time is the unequal distribution of power in America, and the grave human consequences of that imbalance. From climate change and unaffordable housing to police brutality and the health care crisis, the major issues of our day feel intractable because of the vicious feedback loop between racial, economic, and political inequality. She has spent her career studying and describing and fighting against against those inequalities, putting the lived reality of working families first.
2. Policy chops. Warren is the wonk’s wonk. Beyond her deep expertise in many policy fields, she has a track record of surrounding herself with creative thinkers who dream big and reimagine what is possible. It is a crucial skill set for this political moment, and will make her especially effective at using executive action to accomplish progressive goals.
3. An eagerness to listen and learn. In their endorsement of her, Black Womxn For commended Warren for being “willing to learn, open to new ideas, and ready to be held accountable by us and our communities.” Warren is the polar opposite of Donald Trump: self-confident enough to seek out and thrive upon constructive criticism. And out on the campaign trail, you can see something special when she holds a little girl’s hand and looks her in the eye: Warren actually views herself as a public servant, working for us and our children.
4. The courage to fight. Over 10 years ago, as the economy collapsed, Warren seized the political moment and proposed creating a consumer financial protection bureau that would deliver for working families every day. Wall Street spent millions lobbying against it. The insiders said that she should give up. Nevertheless, she persisted. She marshaled a grassroots movement. And she won. That kind of determination, married with the powers of the presidency, is what we need if we are to defeat the modern-day robber barons driving our political economy into the ground.
5. A mastery of leadership. Leading the federal government well requires serious management skills. Setting a vision, assembling the right leadership teams, deciding what to prioritize and how, inspiring action, demanding and obtaining the results you want… Sorry, I’ll stop, since I’m starting to sound like a terrible book jacket. But this stuff actually matters, and Warren can do it.

Since my diagnosis with ALS three years ago, I have spent much of my time advocating for Medicare for All. Warren shares that goal. And über-wonk that she is, Warren has recently articulated in detail how to pay for and transition to a single-payer health care system. I’ve written previously about why I think her funding plan is smart policy and even smarter politics. Now, I want to explain why I think the same is true of her transition plan.

The plan begins on Day 1 of her presidency, with some important executive actions to lower prescription drug prices and constrain the political power of big health care companies. Then, in her first hundred days, she will ask the Congress to pass a massive expansion and enhancement of Medicare, including a generous Medicare for All option. Here’s what that law would do:

• Radically improve Medicare so it fully covers long-term, dental, vision, hearing, mental health, and substance abuse treatment.
• Lower the eligibility age for Medicare to 50, giving 57 million people the ability to enroll immediately.
• Create a Medicare for All option that offers totally free, comprehensive health care to 135 million Americans—every child under 18 and every person making at or below 200 percent of the Federal Poverty Level (roughly $51,000 for a family of four). Everyone else would have the option to enroll at low cost, capped at 5 percent of income with costs automatically going to zero over time. Giving people the ability to buy in to Medicare immediately ensures that the insurance companies won’t game the system. We know that they, seeing they are getting pushed out of the marketplace, will likely raise premiums for the sickest people and kick many off their existing insurance plans. The buy-in—which is in both the House and the Senate bills—allows us to make sure we protect everyone.

We can and should talk about our strategy and our tactics. But what matters most to me is that Warren is all in for Medicare for All. Her plan says clearly that by the end of her first term, everyone will have comprehensive guaranteed Medicare—whether you are rich or poor, young or old; that there will be no co-pays, premiums, or deductibles; and that we will bring down the costs of health care because private insurance companies will no longer be able to put profit over patients.

There are two facts about the Warren proposal that I especially like. First, it lowers the age of Medicare eligibility to 50 immediately, getting even more people onto Medicare in the first year than Sanders’s bill, which has an eligibility age of 55. Second, Warren also adds in full long-term care, which matches Representative Pramila Jayapal’s Medicare for All bill in the House. That is an enormous addition for our seniors and people with disabilities. I know firsthand just what this will mean for millions of people across our country to have this kind of care available to them.

Warren’s proposal boldly states that she will use budget reconciliation to get many of the changes in her first and second year. This is important, because budget reconciliation requires only 51 votes in the Senate. Republicans use this all the time, and used it for the tax scam they passed last year. But unfortunately, even past Democratic presidents have balked at availing themselves of this simple tool. Warren makes clear that she will use all the tools available to provide Medicare for All–type care to as many Americans and as quickly as she can—and then she will complete the final part of her plan in the last two years by transitioning the remaining people into that same comprehensive care.

Across the country, people are dying because they do not have the health care they need. And we need to keep focused on achieving universal health care for everyone. Our movement is making so much progress, with over half the Democratic caucus signed on to the House version of the bill, three hearings in major committees in the House for the first time ever, and three more upcoming hearings also in major committees. More than three dozen labor unions, a powerful racial justice coalition, and hundreds of businesses across the country have said this is the necessary step for the richest country in the world to take. That’s what we are all ultimately fighting for.

For progressives like me—and maybe you—the choice in this primary is between Warren and Sanders. It is a difficult and wonderful choice to have. The two of them are close allies in the Senate, with deep admiration for each other. Sanders himself said that Warren “blew me away with her ability to deal with complicated economic issues in a language that people could understand.… So I’m a big fan of Elizabeth Warren.” I believe that either one of them would be the best, most progressive president in modern US history. (Neither’s record, I am confident, would have flaws as devastating as LBJ’s atrocities in Vietnam and FDR’s acceptance of Jim Crow.)

Inside the progressive movement, some of the most sophisticated and effective organizers have endorsed Warren and others Sanders, some organizations Sanders and others Warren. I admire and love Bernie. I have schemed with him, worked with him, and campaigned by his side. He has done more than anyone else to build the movement for Medicare for All. He is a human being, with human shortcomings—just like Warren. But I don’t want to highlight those or criticize him, because I think he, like she, would be a transformative president.

I believe it is healthy for progressives to get involved in the campaign now and start building our muscles for the general election. In 2020, we face a battle with fascism for the future of our democracy and our planet. Before that, we must fight a corporate establishment for the soul of the Democratic Party. I believe that Warren is the leader we deserve for those battles. You may prefer Sanders, and I have deep respect for that choice. But during the primary, I think we should keep perspective. We are, ultimately, on the same side. When the dust settles, Warren will enthusiastically endorse Sanders, or vice versa, and then we will need to all struggle together, as one progressive movement.

Ady Barkan made this endorsement in his personal capacity

Over the weekend, Republican House minority leader Kevin McCarthy said he would seek to formally sanction the first two Muslim congresswomen, Ilhan Omar and Rashida Tlaib, because their criticism of Israel’s occupation of Palestine was even more reprehensible than Congressman Steve King’s defense of white supremacy. What motivated McCarthy’s false accusations of anti-Semitism? On Twitter, Omar suggested, “It’s all about the Benjamins baby,” quoting Puff Daddy’s ’90s paean to cash money. Omar subsequently specified that she was talking about spending from the likes of the American Israel Public Affairs Committee, better known as AIPAC, the powerful pro-Israel lobbying organization.

By Monday morning, AIPAC had mobilized its allies to condemn Omar’s comment for playing into centuries-old anti-Semitic tropes that wealthy Jews control the world. Even the Democratic leadership put out a statement condemning her. All because she dared to point out that the emperor has no clothes.

As a Jew, an Israeli citizen, and a professional lobbyist (ahem, activist), I speak from personal experience when I say that AIPAC is tremendously effective, and the lubricant that makes its operation hum is dollar, dollar bills.

In 2006, fresh out of college, I landed a job as the first real staffer on a long-shot Democratic congressional race in deep-red Ohio. My boss, Victoria Wulsin, was a charming hippie doctor with a lefty perspective on international affairs. She was skeptical of military force and opposed to the Israeli occupation of Palestine.

About a month after winning the Democratic primary, we were struggling to gain attention or money. Nobody gave us a chance to win. One political-action organization, however, did reach out to us. It wasn’t Emily’s List, although Vic was fiercely pro-choice. It wasn’t a labor union or even a doctors’ association. It was AIPAC.

A local Democratic volunteer leader of the Cincinnati AIPAC chapter sat down in Vic’s living room and I recall him saying that he would like to raise $5,000 for our campaign and would also like to see Vic take a public stance on two relatively obscure issues relating to Iranian sanctions, arms sales to Israel, or some other such topic that very few voters in the district cared about.

Vic and I both thought of ourselves as pro-peace, not pro-Israel. We both felt icky about doing it; it was too hawkish and too quid pro quo. But we were desperate. So I read the AIPAC position papers that the volunteer left with us, I wrote up a statement saying that Vic supported AIPAC’s stance on its two pet issues of the cycle, she approved it, I posted it online, and the checks promptly arrived in the mail thereafter. We didn’t win, but the money helped us get close.

It was, I am ashamed to say, definitely about the Benjamins. We never would have done it otherwise. AIPAC’s power is about more than money, certainly. It’s about great organizing (they built a local chapter, and sent a local Democratic volunteer emissary who then facilitated the contributions). It’s about diligence (they paid attention to Vic’s campaign long before anyone else, and were happy to donate to both us and the militaristic, pro-Likud Republican incumbent). Their lobbyists on the Hill are the best in the business, and their legislator junkets to the Holy Land are masterfully orchestrated. But money is central to the whole system.

Technically, AIPAC doesn’t make the political contributions. Instead, as it notes proudly on its website, individual members of its “Congressional Club,” like that Cincinnati resident, do the bundling and donating directly, both as individuals and through Political Action Committees that AIPAC and its members have set up.

Omar is right to point all this out. These dynamics are not unique to the Israel-Palestine issue, however, and there is no reason that Americans should be surprised or offended by what she and I are saying. The NRA and the broader gun lobby operate in the same way. Same with ExxonMobil and the fossil-fuel lobby. But since Omar and Tlaib are powerful new spokeswomen for the movement to end the Israeli occupation, delegitimizing them is a central aim of the Israel lobby.

AIPAC and its partners, which include Christian Zionists and military contractors, are a central pillar of the Israeli occupation. Without congressional support, the Likud/anti-Palestine/pro-occupation project would be radically undermined. The money that AIPAC and the rest of the lobby spend is indispensable to that work. That’s why they spend it. Pointing this out is not anti-Semitic.

We do, in fact, have a growing anti-Semitism problem in America. But Omar and Tlaib are not a part of it. They are allies of mine and of Jews across this country who are fighting for peace, racial justice, immigrants’ rights, and the defeat of fascism. The anti-Semites are the Nazis and white supremacists who marched and murdered in Charlottesville, whom Donald Trump called “very fine people,” and the MAGA supporter who massacred worshippers at a Pittsburgh synagogue.

The Israel lobby flexed its muscles in response to Omar’s tweet. Almost all of Capitol Hill, sadly including the Democratic leadership that I have supported, was up in arms. It flexed with equal potency last month in marshaling through the Senate a clearly unconstitutional law to ban speech promoting a boycott of Israel.

For 12 years, I have harbored minor private shame for advising Vic to endorse AIPAC’s position papers and more significant shame for not doing enough to stop the oppression of the Palestinian people.

I am speaking up now because it may be my last chance. Although I am only 35, I am dying. As I write these words, I am sitting with my wife in the waiting room of the Santa Barbara hospital emergency room, slowly bleeding from my stomach into a pile of gauze. I had a feeding tube inserted four days ago but it isn’t healing properly. I am losing the ability to swallow, because I have ALS, a poorly understood neurological disease with no treatment, which seized my body 28 months ago and has basically paralyzed me since. My hands do not work and almost nobody can understand my mumbling, so I am using amazing technology that tracks the location of my eyes and allows me to slowly type out these words with my pupil-tips.

This is my chance to redeem my Jewish guilt, to speak out against the oppression that is being perpetrated in my name, and I do not intend to let a minor obstacle like ALS stop me.

Young Jews across America increasingly agree with Omar and me, and that is making the Israel lobby very nervous. As it should: The occupation is too immoral, illegal, and inhumane to survive an open and honest conversation in the marketplace of ideas. That is why AIPAC and its associates work to silence criticism of Israel by accusing its detractors of anti-Semitism and claiming that nobody may ever talk about how the Israel lobby uses money to build power.

The ugly truth is that the Israel lobby, like other powerful lobbies led by Jew and gentile alike, wields its money strategically and effectively. Outrage should be directed not at those who point this out (most often Muslims and people of color) but at the suffering of the Palestinian people and the simultaneous dependence of the Republican Party on genuine anti-Semites.

I do not expect to live to see the liberation of the Palestinian people. But I maintain hope that my toddler son will. If he does, it will be because young American Jews like him do the honest self-reflection taught by our forebears, take pride in our tradition of justice, and join in solidarity and struggle with fellow Semites like Omar.

On September 30, 2016, Rachael and I celebrated one year of marriage and 11 years together by booking a hotel room in Los Angeles and going out for fancy Asian fusion. It was our first night away from our 4-month-old son, Carl. Rachael had a great new job as an English professor in Santa Barbara. My career as a progressive activist was going gangbusters. We had just bought a beautiful house and could see decades of happiness stretching out ahead of us. We were the luckiest people we knew.1

The next morning, we had brunch with my oldest friend, a first-year medical resident. I mentioned to her that my left hand was feeling weak, and after playing with it for a few minutes, she told me I needed to see a neurologist.2

The following Friday, at the ripe old age of 32, I was given my death sentence: The doctor told me I had ALS—amyotrophic lateral sclerosis—which would rapidly destroy all the connections between my brain and my muscles, leading to complete paralysis and death, likely in three to four years.3

Three weeks later, our world was turned upside down a second time, when America elected a racist kleptocrat to the White House.4

Like many people suddenly confronted with agonizing loss, I looked for answers in Buddhism. Pema Chödrön teaches us that when the ground disappears beneath your feet, the solution is not to flail around in a desperate attempt to find a handhold; it is to accept the law of gravity and find peace despite your velocity. Leave the mode of doing and enter the mode of being. Accept things as they are, rather than yearning for them to be otherwise.5

Such radical acceptance is in tension with my identity as a movement builder. Activism is precisely about not accepting the tragedies of this world, but rather on insisting that we can reduce pain and prolong life. Social justice means creating a stable floor beneath our feet and then putting a safety net under that, to catch us if it suddenly vanishes: universal health insurance, affordable housing, unemployment benefits. Being part of a progressive political movement is about fighting back and building toward a better future. “Acceptance” is not part of our vocabulary.6

The theologian Reinhold Niebuhr—whose most famous disciple, Dr. Martin Luther King Jr., would become the patron saint of American organizers—sought to resolve this tension in his Serenity Prayer: asking for the serenity to accept what cannot be changed, the courage to change what can be, and the wisdom to know the difference.7

I have tried to internalize this worldview. I am no longer ruffled by quotidian nonsense, or even by the onset of new symptoms, such as when, earlier this month, I stopped being able to feed myself. I have come to accept that my ALS is progressing faster than average, that my body is wasting away quickly, and that what I have today will soon be gone. But there is one thing that still overwhelms me: when I imagine the future life of Rachael and Carl, who is now 2. The weekend hikes, the afternoons on the basketball court, the evenings playing backgammon and doing homework, the mornings eating breakfast and laughing about the latest absurdity emanating from Washington, DC—these are the moments that I picture spending with them in an alternate universe. When this mental exercise brings me to tears, as it always does, I try to be at peace in my sorrow. But it is not easy.8

Because of the weakness in my lips and tongue and my shortness of breath, becoming emotional makes it difficult for me to utter the words you are reading. My fingers have lost nearly all of their strength, so typing these words is impossible. Instead, I sit with my scribe, Aiyana, in my room. She now understands me better than anyone else, but even she has begun to ask me to repeat myself. Even when it is quiet. Even when we are sitting side by side.9

For 20 years, since I was a freshman in high school, I have been writing newspaper op-eds and giving timed speeches—first on the debate team and at thespian festivals, later at press conferences and in community-organizing meetings. But never before have I felt so acutely the constraining force of my word-count limit. I know intuitively how many arguments I can fit into 800 words. I know when my three minutes are up, even without looking at my watch. But now, facing my final months of speech, the questions that I was taught to ask in high school have taken on new meaning: What do I want to say? To whom? And how?10

I spent six weeks this summer driving across the country in a wheelchair-accessible RV with a dozen comrades in pursuit of answers, not only to my personal queries but also to our national ones. What kind of a country will Carl’s generation inherit? And what will it take over these coming precious months to save our democracy? In 20 states and the District of Columbia, we met citizen-activists who are grappling with these very same questions, pouring their entire being into crafting tolerable answers. Some, like me, are dying and are throwing themselves into this November’s elections because they know it may be their last chance. But many others with longer life expectancies are doing the same thing. It turns out that our collective time horizon is the same: We peer into the future and hope that our children’s children will grow up in a more just and equitable society.11

In nearly every congressional district, voters say that their top concern is health care. The high cost, the lack of access, the bureaucratic headaches—I heard these complaints in small towns, big cities, and suburbs from coast to coast. But these complaints are symptomatic of a much more profound problem: Our democracy is broken, and it seems that we have lost the ability to solve our collective challenges. Everywhere we went, we met voters who had been disabused of the notion that our elected representatives are pursuing the public good, disabused of the quaint idea that our government is of the people, by the people, and for the people.12

And yet, throughout our travels, this cynicism was being overcome by a different emotion—hope. All around the country, we met people who can see beyond this dark moment into the bright light of another world. For the first time in many decades, our national politics are being shaped not only by fear and hatred, but also by our dreams for a better world. Each month, more organizers, activists, candidates, and elected officials are talking about reshaping American society in a radically humane way. This vision encompasses both negative and positive rights: freedom from unjust incarceration, racist policing, inhumane immigration enforcement, economic exploitation, sexual violence, and political disenfranchisement; and a set of public policies that gives us the freedom to thrive—debt-free education from pre-K through college, decent housing, the guarantee of a good job, clean energy, retirement security, and free and robust Medicare for all.13

Focusing on the moment and immersing myself in the task at hand has been my salvation over the past two years. Peering into the future has been too dispiriting and too overwhelming. But there is so much to embrace in this very moment, so much work right here in front of us.14

This was the message that I settled on somewhere between the cornfields of the Great Plains and the glistening waters of the Great Lakes: the notion that the cure to what ails American democracy is more American democracy; that our problems are created by people and that we can only solve them with people power; and that, as Rebecca Solnit teaches us, hope is not a lottery ticket that can deliver us out of despair, but a hammer for us to use in this national emergency—to break the glass, sound the alarm, and sprint into action.15

What action? Voting is not nearly enough. This moment calls on us all to become organizers. To be heroes for our communities and future generations. To talk to our less political friends, neighbors, classmates, and co-workers, and to enlist them in this experiment we call American democracy. This is our Congress, our country, and our future for the making.16

The past few weeks have borne witness to the potency of hopeful organizing. In the summer, the conventional wisdom in Washington held that Brett Kavanaugh was a sure bet to be confirmed to the Supreme Court. But in August, a handful of organizations began a campaign of civil disobedience to resist him, and in early September, as the Senate reconvened for what was supposed to be a smooth confirmation process, more than 200 brave women said no. They disrupted the hearings, focused the nation’s attention on the moral stakes of the nomination, and created space for bold Democratic senators to push Kavanaugh on his immoral ideology and dishonest testimony.17

Meanwhile, over 123,000 American citizens pooled their small contributions into a $3.5 million war chest and joined activists in Maine to deliver a clear message to Senator Susan Collins: If you vote for Kavanaugh, it will cost you your job. Collins, Fox News, and Senator Ted Cruz of Texas complained that we were engaging in bribery. That is their ideology in a nutshell: Corporate donors can buy all the access and influence they want, but regular American citizens must remain silent. This response is as old as class hierarchy itself, because there is no more dangerous threat to the status quo than collective action by the masses.18

In late September, Kavanaugh’s confirmation was thrown into doubt because Christine Blasey Ford testified that he had attempted to rape her in high school, and most Americans believed her. In an act of mass solidarity with Blasey Ford, thousands of survivors told their stories for the first time. The #MeToo movement has been building public consciousness for a year, and its legion of members were determined to prevent the Senate from repeating its embarrassing performance in 1991, when Anita Hill testified during the Clarence Thomas confirmation hearings. Hundreds of survivors and their allies boarded buses to DC; thousands more organized rallies and vigils in their hometowns. In Senate offices and elevators, on Facebook and around the dinner table, a mass movement of Americans insisted that we deserve so much more from our Supreme Court and our Congress.19

Some of us even entertained the fantasy that we might be able to run out the clock until a new Congress convenes in January and possibly save this Supreme Court seat. One can hope. And then organize. And sometimes that struggle will pay off.20

Sometimes, though, our struggle is not enough. ALS destroys my body, no matter how many medicines I take or exercises I do. Sometimes, oftentimes, white supremacy, violent misogyny, and rapacious capitalism rip apart our families and destroy lives, regardless of how well we organize. And sometimes, oftentimes, our stories are not powerful enough. Despite our best efforts, Brett Kavanaugh has been confirmed, and will do lasting damage to America and its people.21

Yet it is in these moments of defeat that hopeful, collective struggle retains its greatest power. I can transcend my dying body by hitching my future to yours. We can transcend the darkness of this moment by joining the struggles of past and future freedom fighters. That is how, when we reach the end of our lives and look back on these heady moments, we will find peace in the knowledge that we did our best.22

There is a seeming paradox embedded in the third part of Niebuhr’s prayer, because the wisdom to know the difference between what we can and cannot change can only be earned through struggle. Neuroscientists seek a cure for ALS because they do not accept its inevitability. Organizers rage against the machines of capitalism with that same determination. It is only by refusing to accept the complacency of previous generations that the impossible becomes reality. For me, Niebuhr’s prayer is most true if rearranged: Collective courage must come first, wisdom second, and serenity at the very end.23

You are a progressive. You hate Trump. You always vote, even in the primary. You went to the Women’s March. You sometimes volunteer or donate to electoral campaigns.

You believe that Brett Kavanaugh poses a serious threat to American society. A fifth conservative on the Supreme Court would mean horrible things for our access to health care, our voting rights, corporate control of the economy, environmental protection, and, of course, accountability for President Donald Trump and his cabal.

You also believe Professor Christine Blasey Ford. You think it would be an abomination to elevate to the Supreme Court a man who has perpetrated such violence and lied about it so cavalierly.

But Donald Trump will not give up so easily. He and his allies will push as hard as they can to get Kavanaugh confirmed. Stopping them will take our full commitment of body and soul.

To stop Kavanaugh, you need to come to the Senate this Monday and engage in nonviolent civil disobedience with us. We know that this would be a first for you. We know the idea makes you a bit uncomfortable. But we’ve been doing this work for many years, and we can promise you that there is no more effective thing you can do right now to save our democracy. Let us answer your concerns.

“How will civil disobedience help?”

Two weeks ago, 200 brave protesters changed the entire dynamic of the Kavanaugh confirmation process by disrupting the hearings and giving voice to their objection. Those protesters, like generations of protesters before them, inserted themselves where they were not welcome. They interrupted business as usual, and they drew attention to the moral stakes of this nomination.

The Judiciary Committee will hold a hearing on Monday, and they appear set to take testimony from Ford and Kavanaugh. The nation’s eyes will be upon them. How we, the people, respond will determine the fate of the Kavanaugh nomination.

Imagine what will happen when hundreds of people descend upon the Senate at 9 am on Monday for that hearing. Imagine if wave upon wave of protesters say “no” to sexual violence, “no” to corporate control of the economy, and “no” to Kavanaugh. Imagine if the hallways overflow with nonviolent resistance fighters. They will not be able to overcome the moral force of our voices.

Kavanaugh’s nomination is hanging by a thread. His opposition to abortion rights, his repeated acts of perjury, and now the serious allegation of attempted rape have given even Republican senators many good reasons to vote no.

Decades of American history have shown us that civil disobedience has the power to make unaccountable decision-makers change their behavior. It helped earn white women the franchise. It was integral to workers winning the right to decent pay. It played a crucial role in defeating Jim Crow. It contributed to the end of the Vietnam War. It helped win medical care for people living with HIV. And last year, it saved the Affordable Care Act. It can surely win this battle.

Nonviolent civil disobedience is necessary now because the Republican Party has violated long-standing norms and stolen a seat on the Supreme Court. Now, it is engaged in a process that violates our moral and constitutional values. On Monday, hundreds of us from around the country will come to the hearing to bear witness to Prof. Ford’s testimony. We will not permit a repeat of the committee’s of Anita Hill.

“I wish I could, but I’m busy on Monday.”

We know that you have important obligations on Monday. A big meeting at the office. Your daughter’s basketball game. A long scheduled dinner. A family member who needs your help.

But we also know that this nominee will do tremendous damage to you and your loved ones for years to come. He will harm your health, your financial security, your children’s safety. A Justice Kavanaugh would send a horrendous message to every victim of sexual violence—and every perpetrator as well. Kavanaugh will harm your community, your country, your democracy.

You vote every election, even though there is little chance that your vote will be the deciding factor. You do it on principle. You do it because the stakes are so high. You do it because the small chance of making a difference is worth your time. The same is true here. Time and time again, we have seen how civil disobedience can pull victory from the jaws of defeat. It takes hundreds of thousands or millions of votes to win state and federal elections, and still you vote. We need only a fraction as many people to come to the Senate on Monday to give us a real shot at saving the Supreme Court for a generation. It is worth your time.

“Civil disobedience just isn’t for me.”

You may think of civil disobedience as something that activists do. And you’re not that kind of person. Well, desperate times call for desperate measures. American society is under unprecedented threat. If our children’s children are going to grow up in a democracy, it will be because our generation took responsibility for preserving it. All of the great social-movement victories in our history were the result of ordinary people deciding to leave their comfort zone and step out into the light of collective action. We need you to make that leap now.

“What will it be like?”

Civil disobedience is an invigorating and liberating experience, because it allows us to resist injustice alongside sisters and brothers who share our values. There will be singing and laughing. There will be powerful stories and inspiring speeches. You will be safe. The Capitol Police may even whisper in your ear, “I support you,” as they place the handcuffs on your wrists. You will most likely be asked to pay a “post and forfeit” fine. You will probably not go to jail. If you do, we will have lawyers there waiting for you. But, either way, you will leave Washington, DC, empowered and hopeful, filled with the self-respect that comes from knowing that you are doing everything you can to make this country better. It will be a day that you will never forget.

For answers to more of your questions and to sign up for this act of civil disobedience, go to http://bit.ly/WeBelieveChristine. And if you would like to join us, but do not want to get arrested, we would still greatly appreciate your solidarity. There is room for everyone.

Correction: The hearing and protest have been moved from Thursday to Monday, and the text has been changed to reflect that. Because of the schedule change, Rev. Dr. William J. Barber II will no longer be able to attend. The article also initially had an incorrect byline; Ady Barkan is the sole author of this piece.

Progressives have begun to dream more boldly. We have graduated from a public option to single payer. From lower sentences to eliminating cash bail. From motor-voter to automatic-voter registration. From affordable to free college. And from a $15 minimum wage to guaranteed good jobs for all.

America’s founding sin and its continuing greatest failure is the racialized inequality that has been built into our economy. And, as the 2016 election made clear, the Democratic Party has struggled to imagine an agenda that addresses race and class at the same time. This failure left open political terrain that could be occupied by the racism and corporatism of Donald Trump.

Done correctly, a good-jobs guarantee would largely eliminate poverty in the United States. It would directly and radically improve the lives of long-term unemployed and “unemployable” people—particularly the black, latinx, and Native workers who suffer from both structural and malicious discrimination. It would combat gender inequities. It would facilitate a just transition to a carbon-free economy. It would strengthen our economy’s long-term trajectory and people’s daily lives by creating transit, energy, and communications infrastructure. And it would enrich Americans’ lives by funding child, elder, and special-needs care.

A good-job guarantee would pay for much of itself by eliminating the need for unemployment insurance and for many welfare programs. It would also lower the costs associated with the opioid epidemic and our system of mass incarceration. At the same time, the job guarantee would improve the performance of the private sector by increasing consumer demand, upgrading physical and human resources, and reducing the fluctuations of business cycles. For employees, it would remove the fear of firing that can prevent individuals from fighting sexual harassment, discrimination, corporate abuse, and anti-union activity. It would also tighten labor markets, putting employees in a strong position to improve wages and working conditions.

And it would overhaul our politics by positioning progressives and the Democratic Party as genuine advocates for shared prosperity. A good-jobs guarantee is, in a sense, the succinct sum total of much of the progressive movement’s economic agenda.

Today, on the 50th anniversary of the assassination of Dr. King, we should recommit ourselves to completing the great unfinished work of the civil-rights movement. And there is a political path forward. In just a few years, we can push a good-jobs guarantee from white papers to a presidential signature, but we have to start now.

he concept of a good-jobs guarantee has a proud and privileged place in the history of American progressivism. The first article in Franklin Delano Roosevelt’s 1944 proposal for an Economic Bill of Rights was the “right to employment,” building on the New Deal’s Works Progress Administration, which employed over 8 million people. After her husband was assassinated, Coretta Scott King continued campaigning for economic justice and the right to a job in an effort that helped lead to the 1978 Full Employment and Balanced Growth Act, the ambition of which has never been fully realized.

The idea of a good-jobs guarantee is, after being lost for decades, returning to the limelight. Scholars, led by William Darity and Darrick Hamilton, are articulating updated and concrete versions of the vision. Mainstream news outlets are reporting on their work. And ambitious politicians—most notably, Senator Kirsten Gillibrand, a presidential aspirant, and Richard Winfield, a congressional candidate in rural Georgia—are recognizing its political appeal.

One element of this appeal is the proposal’s simplicity: Any US resident who wants one can get a job, funded by the federal government, that pays a fair wage and provides good benefits. Mark Paul, Darity and Hamilton estimate that the program would employ approximately 13 million people for a cost of approximately $650 billion a year. That is to say, this transformative intervention into American society and political economy would cost less than our current military budget.

The GOP’s embrace of a $1.5 trillion, deficit-financed tax break for the rich finally destroyed the myth that Republicans care about deficits. And America’s $17 trillion national debt, in the face of low interest rates and near-zero inflation, should similarly destroy the myth that deficit spending is dangerous. To the contrary, as economist Stephanie Kelton points out, a public deficit necessarily corresponds to a private-sector surplus. Kelton even argues we should rebrand the public deficit as a “non-government surplus.” The good-jobs guarantee would indeed create enormous surplus for the American people: not only good jobs for all who want them, but also public goods that promote human flourishing and happiness.

eft-wing doctors have for decades been advocating for a single-payer health-care system. But the proposal is suddenly on the verge of becoming dogma within the Democratic Party. Why? How? Although Representative John Conyers had recruited a small army of cosponsors to his legislation over the years, it achieved political liftoff when Senator Bernie Sanders, supported by a few key organizations, placed the issue squarely in the center of American discourse, and forced the Democratic Party to move with him.

We now have the opportunity to do the same with the good-jobs guarantee. Although the last election reminded us how treacherous political forecasting can be, Democrats appear poised for a landslide victory in 2018 and, facing a historically unpopular president, can reasonably hope to repeat the feat in 2020. This year, we can put the good-jobs guarantee onto the political agenda by conducting a mass popular-education campaign, passing city-council resolutions, introducing a bill in Congress, and insisting that the new anti-Trump candidates running for office embrace the proposal now—while they have little to lose and before the corporate influences of Washington, DC, cow them into moderation.

During 2019, progressives will need to move beyond resistance and begin articulating our vision for a post-Trump world. The many vibrant political formations that have emerged since 2017 can continue to excite their membership by making the articulation of a good-jobs guarantee a small-d democratic project. What would you do with a trillion dollars? How would you employ 15 million people? These questions are profound organizing opportunities, because they ask our interlocutors to dream first and make plans second.

A popular-education campaign, directed by no central authority but embraced by many, could generate the enthusiasm and energy necessary to establish the good-jobs guarantee as a viable political concept by next year. Then, the Democratic candidates for president will be forced to embrace it. In 2008, SEIU made support for universal health care a prerequisite for receiving its endorsement; John Edwards obliged, forcing Hillary Clinton and Barack Obama to do the same. The ACA was law within two years. This model can and should be repeated.

But a different lesson must also be learned from 2009–10: That windows of opportunity can close as quickly as they open. If the electoral landslides of 2018 and 2020 are to yield more than those of 2006 and 2008, it will be because progressives have, long before Inauguration Day, laid out a robust vision for social justice in America and have forced the Democratic Party to embrace it.

A good-jobs guarantee should be at the center of that vision. Not only because of the enormous blow it would strike against economic and racial injustice in this country, but also because it advances the priorities of so many interest groups within the famously fractious party. Universal free childcare. National broadband. Mass transit. Public housing. A green economy. Genuine full employment—for all communities. An end to American poverty. In one of the richest nations in human history, these should not be just the stuff of memos, but realities of our lives.

I have ALS, a deadly, incurable neurological disease that is paralyzing my whole body, including my diaphragm. This makes it difficult for me to breathe while lying flat in bed. This month, my doctor prescribed me a Trilogy breathing-assistance machine, which would solve the problem (at least for now). Yet my insurance, Health Net, denied coverage, calling it “experimental.”

But Trilogy is normal standard of care. The doctor’s office told me they had never seen it denied in more than six years of prescribing it. I’m not alone in having my time and energy wasted; millions of Americans have had similar experiences with their insurance provider. Many have suffered or even died, because they didn’t get the care to which they were legally entitled. And, if we don’t fundamentally change our health-care system, there will be many more deaths. Instead of focusing on providing quality care, our system prioritizes shifting costs and maximizing profits.

But what if we had a system where all appropriate care was paid for smoothly and without struggle? We could save enormous amounts of time and money, allow doctors to do their jobs, and let patients focus on living more dignified and fulfilling lives.

My complaint about the denial of coverage on Twitter went a bit viral. I asked the Twitterverse what I should do about the problem: start a petition, file a complaint with the insurance commissioner, or maybe hold a protest. (The vote was a tie between launching a petition and filing a complaint.)

In the end, none of the options was necessary. Health Net called my doctor’s office. “We made a mistake,” they said. The machine will be covered.

I’m glad the problem got resolved. I’m looking forward to breathing and sleeping better at night. But I am outraged about this health-care system. There is zero chance Health Net would have moved so quickly if I didn’t have a Twitter following.

Millions of Americans are denied care every year. Few of them have megaphones to intimidate large companies into quick action. And so they suffer and spend their precious hours fighting with profit-seeking, opaque bureaucracies.

So I have some questions for Health Net about what the company did to me and what it is doing to its other customers. I believe it has a moral obligation to all of us to answer these questions publicly.

1. Why was my Trilogy deemed experimental? By whom?
2. Are the first-line decision-making employees given incentives or instructions to deny coverage when possible?
3. How many times did Health Net use “experimental” as a reason to deny coverage in 2018? How many times did it use another reason to deny coverage?
4. How many times did Health Net customers appeal a denial of coverage in 2018? How many of those customers ultimately obtained coverage?
5. Following this episode, does Health Net plan to adopt any changes to its policies or practices in order to reduce the frequency of improper denials like mine?
6. What is Health Net’s best estimate of how the 2017 tax-code changes will impact its tax liability and net profits in 2018–20?
7. How much money did Health Net spend on federal lobbying (directly or through intermediaries) in 2017? On what issues?
8. What was the total compensation for each member of Health Net’s executive-level leadership in 2017?
9. Approximately how much money will my Trilogy ventilator cost Health Net?
10. Does Health Net believe that health care is a human right?

You can tell from the evolution of my questions, I believe that Health Net’s behavior is a symptom of a broader sickness not just in our health-care system but in our political economy. The flaws in the for-profit health industry derive from and exemplify the most inhumane aspects of capitalism: how the constant pursuit of lower costs and higher revenue incentivizes the erasure of the individual, and of her dignity, from the firm’s consideration. And thus from consideration by the body politic.

It’s an unjust way to run a health-care system. It’s an unjust way to run a country.

And the Republican Party is trying to make it worse. Republicans spent all of 2017 trying to deregulate the health-insurance industry, making it even easier for companies to abuse consumers. Their tax scam kicks out one of the three legs of the ACA stool—the individual mandate, which requires people sign up for insurance—and destabilizes the entire system by removing 13 million people from coverage. And just last Thursday, the Trump administration announced that it would impose unreasonable work requirements for people who need Medicaid—a backhanded way to make it harder for people to access benefits.

Americans are outraged. We see what is going on. More than at any other point in my life, the American people are ready for significant change to our economy and our politics. This year, millions of us will take to the streets and the halls of Congress to demand a very different country. We will say #HandsOff our Medicare, Medicaid, Social Security, and food stamps. We will work indefatigably for a #BlueTsunami2018. And then, throughout 2019 and 2020 we will resist, organize, and vote. In 2021, when we have built the foundation for a political revolution, we will win #MedicareForAll and end this inefficient, for-profit health-denial system. And then we will start to roll back the power of money in our democracy.

Through this collective struggle, we will transcend our individual limitations. And we will all breathe freely soon.