The Congressional Budget Office has scored Republicans’ American Health Care Act, and the picture is bleak. If the House bill passes the Senate, it would take health insurance away from twenty-three million people, reduce others’ coverage, and further raise premiums and out-of-pocket costs on older people and those with more medical needs.

These attacks, which target poorer, older, and sicker people and women with almost surgical precision, would fall on tens of millions of people are already in a dire situation. Nearly thirty million people are uninsured, tens of millions more have insurance but still can’t afford needed care, health-care costs are rising unabated, crushing medical debt is forcing people out of their homes, and tens of thousands of people die every year because the insurance system denies them lifesaving care.

The root of all of these problems is the private insurance system, which by design prioritizes insurance companies’ profits over human lives. Moving to a national, publicly financed, single-payer insurance system would, in one fell swoop, solve all of this. Yet since the days of Harry Truman, no one has been able to muster the power to overcome the opposition of the insurance industry. Leaders like Congressman John Conyers and Senator Bernie Sanders who back universal health care are the exceptions that prove the rule: market-fundamentalist ideologies, lobbyists, and campaign donors still hold tremendous sway over both parties in Washington.