As Democrats in Congress, several GOP governors and medical industry groups are organizing to thwart the Senate Republicans’ last-gasp effort to destroy Obamacare and dismantle Medicaid, allies of House Democratic Leader Nancy Pelosi are attacking Sen. Bernie Sanders for coming to San Francisco to promote Medicare-for-All legislation to create a national healthcare system.

“What is he thinking?” Rep. Raul Ruiz, D-CA, a Harvard-educated physician who is the son of immigrants and represents the Palm Springs region, Wednesday told Politico.com, speaking of Sanders’ Friday rally during the annual convention of the California Nurses Association/National Nurses United Organizing Committee. The unions have been in the forefront advocating for universal healthcare for California and nationwide.

“I’m worried people don’t understand the urgency and the seriousness here,” Ruiz said. “We’re not keeping our eyes on the most important, real, pragmatic threat we have right now: the passage of Trumpcare that would repeal benefits to the American people and create millions more uninsured… It’s as atrocious as the other versions of Trumpcare… In California, it’s going to be devastating.”

The CNA/NNU does not discount the threat posed by the latest Republican proposal to destroy what could part of the foundation for a nationwide healthcare system. But they say there is a deeper undercurrent where the Democratic Party’s national leaders are giving lip service to the idea of a nationwide healthcare system—just as they have expressed reservations about Sanders’ potential presidential candidacy in 2020.

The Vermont senator’s wife, Jane Sanders, told hundreds of convention attendees that Democrats were casting “ageism” aspersions toward him, unlike ex-Vice-President Joe Biden, and said nothing to discourage Sanders’ supporters from thinking he would run again. However, the party leadership’s attack on Sanders and his Medicare-for-All proposal clearly roiled top CNA/NNU officials, who cited national polls finding 62 percent of the public supported government healthcare for all.

“Why are the Democrats doing this?” asked Michael Lighty, CNA/NNU public policy director, on Thursday. “Because they do not want Medicare-for-All; because it is disruptive of their donor relationships. It is disruptive of their political strategy to move toward the center and to capture what they perceive as the professional class vote that is alienated from Trump. And rather than actually understanding the experience of working people are having with healthcare, which is devastating communities, and getting in touch with that, they are wedded to defending the ACA [Affordable Care Act or Obamacare], which is imperfect though a significant reform because that is something they achieved. It is shallow and donor-class based.”

Pelosi made her opposition to a Medicare-for-All reform known late last year, when progressive groups, including the nurses, delivered one-million “Hands-off Medicare” petition signatures to the House Republican leadership, demanding they honor President Trump’s campaign pledge to leave the health program for seniors alone, Lighty said.

“After that event I walked outside with Leader Pelosi and she said we should not do Medicare for All now,” Lighty said. “And that has been her consistent position since December. So this is a concerted effort to say we don’t want to talk about single-payer or Medicare-for-All because we don’t want the Republicans trashing us, we want to trash the Republicans.”

Moreover, Lighty that the same breed of centrist Democrats that blocked the CNA’s effort this past summer to pass California legislation creating a statewide single-payer system are now attacking Sanders and his Medicare-for-All national proposal.

“That’s what I’m saying. And this is very clear,” he said. “Congress member Ruiz is someone who Leader Pelosi has strongly promoted. This is her hometown. Congress member Ruiz is not speaking out about his appearance in San Francisco without the Leader being involved. It simply doesn’t happen. So this is a continuation. And it has to be understood that they like single-payer as a concept. But when it gets viable, like SB 562 in California, where there’s no excuse—the Democrats can’t hide when they have two-thirds in the Legislature and the governor—then it becomes a real test that they have failed. Because the same people like Sen. [Kamala] Harris—we applaud her support for [Sanders’ bill] S.1804, but she has not endorsed 562. And that’s the difference between symbolic support at the national level, and real support for a viable bill that Democrats could enact.”

Rep. Ruiz’s congressional office did not respond to a request to comment. However, the nurses note that Ruiz has a record of siding with industry interests. In 2013, he voted for a one-year delay in the ACA’s coverage mandates for individuals and businesses. While his website lists many actions advocating for Obamacare, he is not among roughly half the House Democratic delegation that is co-sponsoring a national single-payer bill.

Pelosi, for her part, repeatedly has made it clear her top priority is saving Obamacare, not pushing for a national single-payer system.

“I don’t think it’s a [new Democratic Party] litmus test,” Pelosi told The Washington Post last week after Sanders and 16 Democratic senators presented his bill. “Right now I’m protecting the Affordable Care Act,” she said. “None of these things, whether it’s Bernie’s or others, can really prevail unless we protect the Affordable Care Act.”

Jane Sanders on Looking Ahead

These clashing perspectives reflect a split inside the Democratic Party that will only deepen as 2018’s and 2020’s elections approach. However, among the CNA/NNU attendees, there was unwavering conviction that anything short of a national health program that put patients first—ahead of insurance companies, hospital chains and drug makers—would fall short of what most Americans really need.

Jane Sanders, who was interviewed on stage CNU/NNU executive director Rose Ann DeMoro, described how the newly created Sanders Institute was embracing this view, saying it would “focus on the issues that affect people’s lives, rather than getting caught up in the latest scandals, inter-party or even intra-party.”

“We need to pay attention to bringing people together and talking about the real issues and finding common ground that doesn’t just say, ‘Okay, from the right, from the left, let’s go to the center.’ That is what you are going to be hearing a lot of from the media. That is exactly the wrong way to go,” Sanders said. “There is no left. There is no right. There’s right and wrong, and there coming together to say government works for the people.”

The most intriguing aspect of their conversation—between two women who clearly have known and liked each other for years—was about Bernie’s thinking, including what has kept him going all these years, and into the future. Jane Sanders said that they keep their focus on being engaged, being positive and not showing disappointment, because they feel a duty to all the people they represent.

“I have honestly questioned it and said to Bernie, ‘You know, do we want this kind of life?’ At some point, when things are really really difficult,” she shared, when asked by DeMoro how do they keep going? “And it’s not a question of want. He’s said, ‘Do we just say, ‘Never mind, we tried. We did our best. We’re still alive. We’re still breathing. We’re going to continue to do our best in whatever way that we can…’ For him, it’s in his DNA. He just keeps on going. He’s a long-distance runner.”

“I know that the Democrats are trying to keep Bernie from being the next candidate,” DeMoro said. “I notice the Democrats stand for every right, but all of a sudden when it comes to Bernie ageism seems to be a factor with them. ‘Could Bernie run?’ They don’t say that about Joe Biden, interestingly, and he’s like Bernie’s age?”

“Ageism is the last ism that’s allowed,” Sanders replied. “It’s interesting. Do you get dumber as you get older? It used to be with age comes wisdom. In the ‘60s, we did not believe that at all—back then. But this new crop of older guys… It’s something that I think is the easy way to dismiss him… They can’t find anything else, so they dismiss him because of that.”

As this weeks events in San Francisco show, there are attempts within the Democratic Party to dismiss Sanders the man, his ideas and his followers. Nobody knows what will unfold next week during what will be a tremendous healthcare fight in the Senate. But once that battle is over, Sanders will still be out there pushing Medicare for All. His fervent supporters like the nurses will be there with him. And so will centrist party leaders who fear what looks like another presidential bid in 2020.