On November 27th, YouTube pundit and comedian Jimmy Dore proposed a provocative plan to advance the Medicare for All movement: refuse to re-elect Rep. Nancy Pelosi D-CA as Speaker of the House until she brings Rep. Pramila Jayapal’s Medicare for All bill H.R. 1384 to a floor vote. Because last month’s elections whittled down the Democratic majority in the House, it would take only a handful of Democrats to hold Pelosi’s speakership hostage. The “Squad,” composed of Reps. Alexandria-Ocasio Cortez (D-NY), Ilhan Omar (D-MN), and Rashida Tlaib (D-MI), could theoretically find sufficient support from among the ranks of the nearly 100 members of the Progressive Caucus. And if successful, progressives could force an unprecedented public debate about the merits of an enormously popular policy that, because of the COVID crisis, Americans have never needed more.

Without a majority of votes in the House, the only way to bring a bill out of committee onto the floor where it can be publicly debated is if the Speaker of the House agrees to do so. (When it comes to Medicare for All, Pelosi never has.) And progressives worry that without a significant pressure campaign, elected Democrats will never be made to answer for why they stand well to the right of the public on the need for universal health care. “Now is the time for progressives to exercise their power, play hardball, and use their power for the benefit of their constituents,” Dore argued. 

Public interest in the scheme spiked on Friday night when Rep. Alexandria Ocasio Cortez weighed in via a Twitter reply to Chargers running back Justin Jackson, who has adopted Jimmy Dore’s call to action. “If @AOC and the squad don’t do what @jimmy_dore has suggested and withhold their vote for Pelosi for speakership until Med 4 All gets brought to the floor for a vote… they will be revealing themselves,” he wrote. “Power concedes nothing without a demand.”

AOC disagreed with the proffered scheme on the basis that Jayapal’s Medicare for All bill is unlikely to pass at this time. “So you issue threats, hold your vote, and lose. Then what?” she asked. Instead of demanding a floor vote, AOC countered that progressives could “use leverage to push for things that can happen and change lives.” As an example, she offered a $15 minimum wage in the first 100 days, and “elevating longtime progressive champions to important positions in democratic leadership.”

But progressives pointed out that a $15 minimum wage is part of the Democratic Party platform. “Biden already supports a $15 min wage,” tweeted journalist Aaron Maté. “It won’t take progressive leverage to hold him/Pelosi to something Biden already supports. It’s the Senate that will decide it.”

And unlike other progressive priorities such as student debt cancellation or the provision of stimulus checks, initiating a floor vote is wholly within Nancy Pelosi’s purview: it’s a power she can exercise unilaterally to protect her position without relying on Biden to modify his policy priorities to protect her. (Recently leaked audio of a contentious meeting between Biden and the leadership of Civil Rights organizations exposed how unyielding Biden can be to any agenda not his own.) 

Comprehensive health care coverage is the most pressing political issue of the moment. Since the beginning of the pandemic, over 14 million Americans have been kicked off their employer-based health insurance as they lost their jobs to the shutdown. After a Democratic primary race in which nearly every candidate fought to protect the private health care industry on the grounds that voters deserved a “choice,” millions of Americans are now experiencing the cruel caprice of a system that links health care access to one’s ability to work.

Perhaps unsurprisingly, support for Medicare for All has reached historic highs during the pandemic. Even a Fox News exit poll showed that 72 percent of Americans support a single payer system, and impressively, about half of Republicans support Medicare for All. But importantly for the purposes of the Dore proposition, a whopping 88 percent of Democrats support the policy. A floor vote on Jayapal’s bill could capitalize on the public’s overwhelming approval for Medicare for All, and expose the chasm between the policies Democratic voters want and the positions their elected representatives are willing to take. It’s difficult to imagine a better historical context for this fight. 

Critics of the plan argue that demanding a floor vote for a bill that won’t pass the House, much less the Senate, wastes progressives’ political capital. “We already know who supports [Medicare for All],” argued Ryan Grim of the Intercept, “and I can promise you it would get zero press coverage because the press doesn’t cover bills that can’t pass both chambers.” But recent history offers a counterpoint to Grim’s claim that the media won’t cover a standoff over health care. Just a week ago, the passage of the House bill decriminalizing marijuana was covered widely as “historic,”—perhaps because, like Medicare for All, it’s an enormously popular policy with bi-partisan support. (It’s also unlikely to pass the Senate.) And that was without the added drama of the most powerful Democrat in the House being bent over the proverbial barrel by a squad of progressive upstarts. 

Moreover, the Squad has a unique ability to attract media attention. Representatives Ocasio-Cortez, Katie Porter (D-CA), and other progressive members of Congress are famously adept at making viral moments out of congressional hearing testimony, and if they were to coordinate with the activists and protesters who helped to organize the historically large mass protests from this summer, it’s difficult to imagine they’d be ignored. (Leveraging organized labor and the threat of a general strike would make any effort to push Medicare for All impossible to brush off. And they should do exactly that.) 

Mass unemployment and the subsequent loss of employer-based coverage has stripped corporate Democrats of one of their most potent arguments against Medicare for All: that maintaining the for-profit health system offers much-desired stability. And commitments to cover COVID-related costs have exposed the hypocrisy inherent in defenses of our current system. The admission by party leadership that COVID treatment should be free for all is a slippery slope to universal coverage. After all, it’s not more inhumane to deny COVID treatment to those who can’t pay for it than to deny treatment to a cancer patient who can’t pay. (Cancer is a primary cause of bankruptcy in America.) Should progressives force a floor vote, they’d be well positioned to make a relatively unencumbered case for Medicare for All.

A floor vote and the debate that comes with it could spark a referendum on our failing health care system at a moment when no other issue takes credible priority. “Now is the time [progressives] have power,” Dore argued. “In two years, the Democrats are going to get wiped out in the House. They will lose their majority and their speakership. The only time the progressives are going to have any power is right now at this moment,” before the Speaker is elected in the first week of January. Dore’s prediction that Democrats will lose seats during the 2022 midterms is far from guaranteed, but given the party’s recent losses there is a certain pragmatism to his urgency. 

Agitating for a floor vote also doesn’t foreclose making other demands at the same time. On his blog the Daily Poster, journalist David Sirota offered a number of alternative strategies to advance Medicare for All, including ousting Rep. Richard Neal (D-MA), a Medicare for All opponent, from his position as Ways and Means Chair. This is the type of concession AOC alluded to in her response to Jackson, and it’s a meaningful one. But ousting Neal—an obscure figure to the average American voter—is unlikely to generate the kind of movement energy that a Medicare for All floor vote could potentially inspire. 

The argument is both and, not either or. But crucially, technocratic solutions must be wedded to the floor vote demand in order to spark the kind of public excitement that can galvanize labor, social movements and voters. Progressives are buzzing with excitement because Democrats might, for once, do something bold; they might fight for something not because the cost/benefit analysis demands it, but despite the potential political costs. And the threat of ousting Nancy Pelosi—who 3/4 of Americans believe should step down—practically guarantees breathless coverage from media figures on both sides of the aisle. 

In her response to Jackson, AOC argued that the “opportunity cost” was too high to waste on a floor vote for a bill that wouldn’t ultimately pass. “The Dem votes aren’t there yet,” she tweeted. Why risk negative press from a failed vote if a clean victory is in sight? But a lengthy delay risks wasting the leverage progressives get from a narrow house majority and the exigency of the pandemic. Progressives want to force a vote now precisely because they believe the chance they can secure the votes for Medicare for All in the near future is remote.  If barely half of House Democrats are willing to cosponsor Medicare for All even while it has the support of 88 percent of Democratic voters during a global pandemic, what are the odds the holdouts will be more amenable once the vaccine is distributed and life begins to normalize?

Importantly, even a failing floor vote would force Democrats to own their opposition to a life-saving, popular policy, and it would expose those Democratic House members who are thought to have cosponsored Medicare for All to burnish their progressive bonafides without ever intending to vote for the bill. For example, Kamala Harris and Cory Booker cosponsored the Senate version of the bill but reversed their positions during their presidential campaigns. Forcing a vote on H.R. 1384 would pressure House Democrats to either support the bill or defend their “no” votes as single-payer’s popularity spikes. (Recall how her Iraq war vote dogged Hillary Clinton in both 2016 and 2008, or how both Biden and Bernie Sanders’s votes for the 1994 Crime Bill continue to follow them.) “If [Jayapal’s bill] loses, then we know who is on our side and who is not,” Dore has argued. “Then we can put a marker down.” 

“No” voters would also be forced to justify their position to primary challengers in 2022. “Would love for Democrats to be on the record denying their constituents healthcare during a pandemic,” tweeted Jackson. “Sounds like good politics for the progressive movement and our goals.” Recall that although establishment Democrats attempted to blame Medicare for All for last month’s congressional losses, no swing district candidate who supported Medicare for All lost on November 3rd. Despite the hand-wringing of pharma-backed corporate Democrats, Medicare for All is a winning issue. 

The desire to push Pelosi into allowing a vote and to have hearings in the House on Medicare for All  is born out of a longstanding frustration with the media, which historically shields Democrats from accountability to their constituents when it comes to health care. Mainstream outlets rarely challenge anti-Medicare for All Democrats on why they’re bearish on the policy their constituents overwhelmingly support. And pundits on liberal networks regularly adopt disproven right-wing talking points about the affordability of the program. Moreover, the relationship between candidates who oppose Medicare for All and their corporate-funded campaigns is rarely, if ever, examined, and voters are left to assume that their representatives decline to support Medicare for All because it’s not electorally viable, rather than because they’ve accepted significant sums from the pharmaceutical and private insurance industries to finance their campaigns. 

As COVID raged last spring, President-elect Biden said that he would veto Medicare for All even if it were to pass the House and the Senate. He also received more money from insurance and pharmaceutical industry employees than any other candidate in the race, and his senior advisor is a former health care lobbyist. During the primary, he received crucial ninth inning support from Rep. Jim Clyburn of South Carolina, whose endorsement is considered to have been critical to Biden’s victory after a string of disappointing primary finishes. Clyburn is firmly against Medicare for All despite the fact that Black voters support the policy more than any other ethnic group. He is also the single highest recipient of  pharmaceutical money in Congress. These connections are rarely made by the press.

According to the Center for Responsive Politics, health care companies spent just shy of $568 million on lobbying in 2018—more than any other industry. And as Bernie’s primary campaign ramped up in the first quarter of 2019, the number of organizations hiring lobbyists to oppose Medicare for All increased by a factor of seven. Record numbers of Americans still support a single-payer system, but positive polls alone aren’t enough to induce congressional support for the policy as long as elected officials are paid to vote the other way. The system needs a jolt. And Dore believes he’s identified the necessary spark.

Ocasio-Cortez herself has alluded to the value of a floor vote on Medicare for All—regardless of whether it would pass.  “The Democratic Party is not a left party,” she lamented this past January. “…We can’t even get a floor vote on Medicare for All. Not even a floor vote that gets voted down. We can’t even get a vote on it.” 

At the end of the day, the moral case for action requires no strategic justification. As Kyle Kulinski, co-founder of Justice Democrats—the progressive PAC that backed AOC’s historic 2018 run—tweeted: “If your politics comes from a place of principle then all the strategy talk is pretty silly anyway. If you believe in something you fight for it & dot every i & cross every t. If you lose ok but the act of doing everything in your power to achieve it is the definition of morality.”

An earlier version of this article stated that 15 progressive Representatives would be needed to hold the vote for Speakership hostage; that number is in flux, but likely 5-7.