By Michael Sainato

Progressives have united behind the push for Medicare for All over the past year. But even in Democrat-dominated California, the state legislature has stymied opportunities to pass a statewide Medicare for All system, sparking electoral battles across the state as progressives attempt to replace Democratic Party leaders who oppose the bill.

State Senator Richard Pan, strongly backed by the California Medical Association, was one of three Democrats in the state Senate who withheld supporting SB 562 Medicare For All last year. The bill passed the state Senate, but the Democratic Party’s Assembly Speaker Anthony Rendon shelved the bill, preventing the state assembly from voting on it. Senator Pan is one of several Democrat incumbents in California facing challenges from the left, as activists work to make California live up to its reputation as one of the most progressive states in the country.

In 2014, Pan won his State Senate seat in large part by spending seven times more than his opponent in the Democratic Primary. Since 2012, the California Democratic Party has received over $1.2 million from organizations opposing the Medicare For All Bill, SB 562, and more than $2.2 million from the pharmaceutical and health insurer industries. In 2016, the pharmaceutical and medical industry spent over $100 million to oppose a ballot amendment, Proposition 61, that would have allowed the state government to negotiate for lower drug prices, as the Department of Veteran Affairs does.

Incumbents are presumptively endorsed for re-election by the Democratic Party in California unless a primary opponent meets certain requirements to challenge that endorsement. The California Democratic Party’s endorsement of Pan for re-election was formally challenged last month by progressives who managed to successfully reach the threshold for petition signatures — but establishment Democrats rallied the state party’s version of superdelegates to stave off the endorsement challenges.

Democratic Party leaders have a large number of delegates to sway internal party decisions in their favor, says Karen Kernal, chair of the California Democratic Party Progressive Caucus.

“The leadership of the party gets multiple appointee votes while the average delegate get their sole vote,” Bernal told The Real News Network. “This allows for massive ‘stacking’ in these district contests by the leadership—a tool used to further entrench incumbency and those ‘bought’ by corporate interests.”

The California Democratic Party’s efforts to protect Pan’s re-election represents another battle in the broader fight between party leaders and progressive activists over Medicare For All, as well as other progressive policies that the California Democratic Party has yet to pass, despite holding a supermajority in the state government.

The California Medical Association, Hospital Association, and pharmaceutical industry have lobbied Democratic Party leaders to oppose Medicare For All, while ensuring the industry’s allies within the party are protected from challengers who support it.

“The industry’s talking points had some real effect, particularly when they were being parroted by the assembly speaker, Anthony Rendon,” said Derek Cressman, a progressive activist who is challenging Pan in the Democratic primary this year. “I spoke to multiple delegates who really had sort of convinced themselves that it was impossible for the world’s sixth-largest economy to do what places like Canada have done, because we somehow couldn’t afford it.”

Due to the popularity of Medicare for All, Speaker Rendon and the California Democratic Party have openly claimed to support Medicare for All, but have repeated industry talking points to argue against its feasibility. Cressman noted that careerism is rampant among the Democratic Party’s delegates and serves as a major obstacle in challenging incumbents, as races are viewed through the lens of pursuing individual agendas.

One of the major reasons to prevent the Democratic Party from formally endorsing an incumbent candidate is that it allows state and county Democratic Parties to give as much money it wants to an incumbent’s campaign. “They can use funds that they would receive from these various industry groups, the doctors’ lobby, the hospital lobby, the pharmaceutical lobby,” Cressman added. “Legislators see that type of money coming in, and know where it’s coming from, and know why it’s coming in, and they make a political calculation that Medicare for All can’t be done.”

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Michael Sainato is a contributor to The Guardian and a journalist based in Gainesville, Florida. Follow him on Twitter @msainat1.