Sometime in 1993, doctors David Himmelstein and Steffie Woolhandler traveled down to Washington, DC, for a meeting with then First Lady Hillary Rodham Clinton. She’d been helming health care reform efforts on Capitol Hill, mastering the ins and outs of policy and soliciting input from every possible expert, with the goal of designing a proposal that her husband could shepherd through Congress and deliver to the American people. Some 37 million of them were uninsured, a problem Bill Clinton had campaigned on solving.

Himmelstein and Woolhandler were unlike the other stakeholders Clinton had been meeting with. Since founding the organization Physicians for a National Health Program, or PNHP, in the 1980s while working as primary care providers in Cambridge, Massachusetts, they’d dedicated their lives to organizing doctors around a single-payer health care system — one that eliminated private insurance in favor of publicly financed care for all. Most health policy players that Clinton consulted in designing what would eventually coalesce into the ultimately doomed “Hillarycare” — a blueprint for a market-based system not too dissimilar from the Affordable Care Act that emerged more than a decade later — saw health insurance as a conundrum best solved by better regulated markets. But Himmelstein and Woolhandler believed the problem was the market itself.

Once they got to the First Lady’s office, they were seated on a couch the exact dusty blue color of Woolhandler’s dress, and they made the same case for single-payer health care financing that they still make today: it would cover millions of uninsured people, it would save tens of thousands of lives, it would cut staggering administrative bloat and curb skyrocketing costs. Clinton was every bit the detail wonk she was reputed to be, and she absorbed the issues quickly. But that wasn’t enough.