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On a good day, when he’s feeling sturdy, Andrew Bauer can run simple errands, like going to Walmart to pick up groceries. On a bad day, which is most days, the stabbing pain in his back and neck leaves the 48-year-old lying prostrate in bed, where he composes long, emotion-filled Facebook posts about politics and tweets about Duke basketball. Sometimes the pain is so intense that the left side of his body feels like it’s burning, like he’s being slowly consumed by an invisible flame.

Bauer, who lives in Durham, North Carolina, has suffered from chronic pain for most of his life, but complications from a recent cervical-spine surgery have made that pain immeasurably worse—and left him completely broke. He can barely pay his bills, and he can’t afford the follow-up treatments and surgeries that doctors have recommended. Since 2015, when Bernie Sanders first popularized the idea of Medicare for All, Bauer has daydreamed about the money that a single-payer health-care system might save him, the freedom from premiums and high deductibles, the kind of life he might someday be able to have.

But Sanders, the only remaining presidential candidate advocating for such a system, suspended his presidential campaign last week. Bauer was crushed. Medicare for All “would have immensely improved my life,” he told me last week. “To look forward and realize that those things are probably not gonna happen … it doesn’t really bode well for my future or the future of anybody like me.”

For loyal fans of political candidates, the feeling associated with the end of a campaign is a specific strain of disappointment: It’s the grief over lost potential, the heartbreak of an unfulfilled vision. But for Sanders supporters like Bauer, that disappointment seems to register as something much more profound. These voters are mourning not only his departure from the race but the loss of something much bigger: hope.

If that sounds dramatic, well, that’s because it is. Since Sanders first brought Medicare for All to the fore, many of his voters have trusted—truly believed—that electing him would not just make their lives better, but could help ensure their survival. Of course, even if Sanders had been elected president, it’s not at all likely that Democrats would have been able or even willing to pass such sweeping changes to America’s health-care system. But desperation guides belief, and there’s a point at which the line between hope and reality blurs. The most essential part of Sanders’s candidacy, for so many of his supporters, was the hope.

Bauer, who lives with his brother in a double-wide trailer just outside of town, has been out of work since August. For six years he worked as a wafer-fabrication operator at a local electronics company, making $12.82 an hour. But he told me he was fired after his spinal surgery forced him to go over the company’s 180-day time-off limit for disability. Bauer, who has health insurance, has been struggling to settle $30,000 in medical debt, and he’s got credit-card debt now too, from trying to pay it off. His long-term-disability insurance never quite gets him through the month, he said, and he’s hoping to qualify soon for Social Security Disability Insurance. He’s tried to use GoFundMe twice to pay bills, but he hasn’t raised much; he’s tweeted at a philanthropist asking for help; and he’s sold things—DVDs, comic books—to make extra cash. Living in constant pain is terrible, but worse is the financial pressure. “The stress is absolutely just insane,” Bauer said.

Roughly 137 million Americans reported facing medical financial hardship in the previous year, according to a 2019 study published in the Journal of General Internal Medicine. Another, published in Health Affairs, found that one in six Americans have at least one past-due medical bill on their credit report. GoFundMe hosts more than 250,000 fundraising campaigns for medical bills every year. Sanders supporters argue that Medicare for All, which would raise taxes but eliminate all other premiums and out-of-pocket expenses, is the only solution that matches the scale of the problem.

With Medicare for All, “every surgery or procedure or injection that I need, I could have done for free without having to worry about the cost or having debt,” Bauer said. He’s spent the past few years channeling his financial stress into progressive activism, joining multiple online groups for people struggling with medical bills, and writing about single-payer health care.

Bauer has known for weeks that Sanders likely wouldn’t be the Democratic nominee. But the coronavirus pandemic, in a strange way, had renewed his optimism: Maybe, between all the calls for universal testing and affordable treatment for COVID-19, more Americans would finally see the need for Medicare for All, he thought. “We were hoping that that would translate into a bump in momentum for” Sanders, Bauer told me, “where he could use that to his advantage in the [remaining] primaries.” Instead, his candidate appeared in a live-stream video on Wednesday to utter the words Bauer had been dreading: “The path toward victory is virtually impossible.”

Bauer said he was “almost despondent” after the senator’s announcement. He immediately logged on to Facebook to write several frustrated posts about Biden and the Democratic Party. In the comments, he argued with people who called him a crybaby. But mostly, he commiserated with his fellow Medicare for All advocates, who, he told me, share an overwhelming sense of despair. That anguish was clear across social media: The day Sanders exited the race, Twitter and Facebook were replete with desperate posts from people about their chronic illnesses, their expensive medications, and their inability to afford them.

Sanders “was our best hope to get these things passed, and now that he’s no longer in the race, it’s hard to imagine those policies becoming a reality,” Bauer told me. “We lost out on something that was really huge.”

The Democratic Party’s presumptive nominee is hardly a conservative when it comes to health care; Biden’s agenda is in some ways more liberal than Hillary Clinton’s was. He campaigned on a promise to expand the Affordable Care Act—legislation he pushed for as vice president—and to offer free coverage to low-income Americans who live in states that haven’t yet expanded Medicaid. As a recent concession to progressives, Biden has also proposed lowering the Medicare-eligibility age from 65 to 60.

But throughout his presidential campaign, Biden has been adamantly opposed to Medicare for All, citing the proposal’s $30 trillion price tag. Last month, he suggested that he might hesitate to sign the bill if it came across his desk. To Bauer, Biden’s plans to improve access aren’t nearly good enough. “If Joe Biden becomes president, I honestly have very little hope that any of this will change,” Bauer said, referencing his own situation. “He opposes everything that Bernie stands for—and those are the things that I need to survive.”

Former President Barack Obama is expected to endorse Biden today, and yesterday  Sanders did the same, securing a promise that, as president, Biden would push for a nationwide $15 minimum wage. Health care was discussed only briefly in their live-streamed conversation. The biggest question of the primary race now is whether Sanders’s supporters will make the same endorsement. Many concerned Democrats have joined together to issue one deafening demand to the senator’s fans: Vote for Biden, or Trump wins again. Some Sanders supporters have already vowed to keep pushing Biden to the left; they’re determined that the revolution will continue without the Vermont senator at the helm.

But others are still busy grieving a future that, just weeks ago, they thought was attainable.

Bauer says he’s voted for the Democratic candidate in every presidential election since 1990, including four years ago, when Clinton went up against Donald Trump. But he doesn’t plan on doing so again.

“Either I will write in Bernie or I will vote for [the] Green Party,” he said. “It’s the only thing I can justify at this point.”

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