Choice looms as another vulnerability for single-payer healthcare. Though some advocates, like El-Sayed, say they would allow private plans to exist alongside M4A, even many sympathetic policy analysts believe few such plans could survive against a nonprofit government competitor. Over time, that would undermine the generous health plans many unions have negotiated - which is why some labor leaders fervently oppose the idea. “Forcing everybody into one-size-fits-all,” for health insurance, says Ted Pappageorge, the secretary-treasurer of the powerful Culinary Workers Union in Nevada, “will guarantee the Republicans win the presidency in 2028.”