Near the end of his rally with Congresswoman Alexandria Ocasio-Cortez in Queens, NY on Saturday, Nov. 19, presidential candidate and Vermont Senator Bernie Sanders asked the crowd to look at the people standing near them and to consider how far they’d go to help a stranger: “Are you willing to fight for that person who you don’t even know as much as you’re willing to fight for yourself?” Bernie wondered if his supporters were ready to make sacrifices for their fellow Democrats and Americans. The sentiment was couched in a sort of polished, Twitter-ready catchphrase, but beyond that, I think Bernie was getting at something pretty basic that often gets overlooked in many liberal conversations: In order to achieve progressive equity, some people will need to make sacrifices.

The most obvious area where this applies is health care, a contentious topic at every primary debate. Nothing elicits furious jabbing and quipping from the Democratic candidates quite like the health care question. It comes down to Bernie Sanders and Elizabeth Warren arguing for a government-funded universal health care system, with the rest of the candidates offering a range of plans, mostly revolving around a public option that would allow people to stay on their private health insurance if they choose. 

The Sanders-Warren contingent makes the case that a public option would simply create an unfair quality divide in health care based on class, and would entirely shirk the goals of streamlining the health care system and eliminating excessive profits for private insurers. If they are right that a single-payer option is best — and I believe they are — we, the voters, need to be prepared to make some sacrifices. And Bernie and Warren need to be more upfront about what those sacrifices will look like.

First of all, if you’re lucky enough to have no complaints about the quality of your health insurance and general health care experience, things would probably get worse for you under a single-payer option. Though the differences aren’t huge, it’s true that in countries with single-payer health care, like Canada and England, appointments with general practitioners have longer wait times and are generally a bit more difficult. The difference would likely be augmented somewhat in the U.S.; such a major transition away from a market-based system is sure to come with its own set of unforeseeable challenges. But the bottom line is that for a good chunk of people, Medicare for All is going to be less efficient than their private insurance. 

Then there’s the question of paying for it. Bernie has been pretty upfront about his plan to raise taxes on middle-class families, with the idea being that overall costs will go down for these families as a result of the reduction in health care costs. Warren has made every effort to dodge the question thus far, but it’s safe to assume her plan is largely the same. According to Bernie, his taxation plan would end up saving the average family about $4,400 annually. Since this number is being provided by his own camp, it should be taken with a grain of salt. But even assuming its accuracy, savings for some families means that some will indeed end up paying more in taxes for Medicare for All than they do under a privatized insurance system.

There are plenty of other potential inefficiencies that could result from a Medicare for All transition, but ultimately those are sacrifices we should be willing to make. If you buy into the new progressive ideology, if the democratic-socialist vision appeals to you, part of your commitment needs to become an acceptance of these changes. If you think people shouldn’t die because they can’t afford private health insurance, then you need to understand that your life might have to be a little more difficult to make that possible.

The responsibility here isn’t entirely on us as voters either. Like a lot of people, I like the ideas that Bernie and Warren talk about — Medicare for All and a Green New Deal — because they’re presented nicely. I understand the political maneuver of not being explicit about exactly what everyone will have to give up for the greater good. But still, some of the burden surely falls on those presenting the ideas to explain what sacrifices we will need to make to progress collectively. The willingness to accept these sacrifices, to fight for someone we don’t even know, falls on us.