It’s a convergence of interests: On one hand, there’s a candidate who, perhaps through conviction and judicious reflection, has concluded that the private health insurance industry should not be legally eliminated. On the other, there are people who are well-compensated for their work in that very profitable industry—Bill Wehrle wrote in his op-ed that he wasn’t a millionaire, but the Washington Post had to correct that claim after finding out that he has a $3.7 million house—who are able to elevate that candidate’s message and maintain his campaign financially.

Buttigieg and his backers have succeeded in making the Democratic discussion of health care about protecting “choice” for those who already have insurance, rather than creating universal coverage for those who don’t. The shift reflects concerns that some (but not all) Democratic voters have about single payer, but it also works to the advantage of insurers who benefit when the possibility of being switched off private insurance onto a single-payer plan becomes conflated with the possibility of being “kicked off” insurance permanently. Not every voter concerned about retaining his or her current plan, meanwhile, might be aware that having coverage doesn’t always prevent Americans from going bankrupt because of surprise bills and/or the accumulated out-of-pocket costs of treating chronic disease. And as New York magazine’s Eric Levitz observed, any public option strong enough to attract millions of Americans would be financially troublesome for the private insurance industry (and thus disruptive for its current customers) regardless of whether it was part of a bill that formally outlawed private plans.

That’s why Buttigieg’s friendly relationship with Big Health Care is more than just a primary positioning issue. Candidates who are elected with the help of executives and lobbyists, and who allocate valuable time toward fundraisers and phone calls with major donors, become elected officials who have good ongoing relationships with executives and lobbyists.