by Ben Palmquist

This article article originally appeared in The Progressive.

Although Paul Ryan’s plan to take health care away from 24 million people came up short, Congress and the Trump Administration are already planning a series of executive actions and legislation that, perhaps more quietly, will achieve many of the same ends. The question is not whether they will cut and privatize health care, but how deeply they will drive the knife.

The health care tumult in Washington has sucked up media attention, but a bigger story—and a much more inspiring one—is developing in the states. From Maine to Hawaii, people are not only resisting Republican attacks on health care, but are laying the foundations for a profound transformation of the American health care system. By redefining health care as a human right—one that state and local governments, as well as Washington, have an obligation to meet—grassroots campaigns are challenging the core logic of the private insurance industry: that health care is a commodity that should be available only to those who can afford it.

Though calls for replacing private insurance with universal, publicly financed coverage are not new, this political moment offers a unique opportunity. In the face of Congress’s sinister attacks on health care, people are turning out to town halls in droves, demanding more public involvement in health care, not less. Polls consistently show that a large majority of people recognize that government has an obligation to make sure that everyone can get care, Bernie Sanders’ call for “Medicare for All” helped make him the most popular politician in the country, and the insurance and drug industries have approval ratings even lower than Donald Trump. The public is way ahead of both parties.

The future of health care hinges not on polling, however, but on power. The insurance industry and its allies hold powerful control over both parties, and have so far successfully blocked every attempt at universal health care since the days of Harry Truman. To win, we need a mass people’s movement. But with Washington under the control of free-market ideologues dead set on an oligarchic agenda that is wildly out of step with the values of the public—and even of their party’s base—our path to power runs through the states.

Campaigning for universal health care in our states is both a moral cause and a strategic one. On a moral level, the for-profit insurance system systematically and brutally denies necessary health care to tens of millions of people. Tens of thousands of people die every year because the insurance system withholds life-saving care.

Strategically, health care offers progressives leverage to create a tectonic political shift not only in how we pay for care, but in how our society thinks about the role of government and the purpose of our economy. Organizing for universal health care challenges our economy’s tragic devaluing of human lives and recenters public policy on people and our wellbeing.

What’s more, because the private insurance system has hurt so many people, health care organizing opens a tremendous opportunity to build unity across lines of race, gender, class, age, geography, ability, and immigration status, and provides a large base of people who have the passion to do the long, hard work of fighting for change.

In just about every state in the country, there is an active and organized grassroots campaign for universal health care, and state campaigns have already achieved significant success. The Vermont Workers’ Center passed a bill setting Vermont on the path toward universal health care, the Campaign for New York Health has twice passed a bill for universal health care through the State Assembly, and the Campaign for a Healthy California has just introduced a bill in Sacramento that has powerful backing from the coalition’s 150 member organizations and their 4 million members.

Some of the most remarkable organizing is being led by the members of the Vermont Workers’ Center, Put People First! Pennsylvania, and Southern Maine Workers’ Center, whose Healthcare Is a Human Right campaigns (which I support) center around the leadership of poor and working class people who are directly impacted by the injustices of the health care system. It turns out that if you spend time listening to the concerns of everyday people rather than to the partisan rhetoric, you find remarkable agreement across the political spectrum and all walks of life. Nobody yearns for “choice” between inadequate insurance plans, high-deductible catastrophic coverage, unrestrained free-market drug pricing, or the other red herrings of Republican wet dreams. What people want is access to health care based on their medical needs, not their wealth; more redistributive taxes and spending; the protection and expansion of Medicaid and Medicare; and price controls to rein in the extortionate rates charges by insurance, drug, and hospital corporations.

Universal health care has long been a dream of the American left. We now have the chance of a lifetime, but if we’re going to win universal health care and refocus our economy on meeting human needs, we can’t afford to be passive, and we certainly can’t follow the lead of the Democratic Party. It’s time to turn down the Washington rhetoric, tune into our friends and neighbors, and get to work.