Sahil Kapur – February 6, 2014, 1:00 PM EST3937

On his first day as governor of Massachusetts, Donald Berwick promises to set up a commission tasked with finding a way to bring single payer to the Bay State. It'll have report back to him within a year -- ideally sooner.

Having run Medicare and Obamacare in Washington for 17 months, he has concluded that the existing hybrid system is too cumbersome and expensive, and that single payer is the right fix. And he's the only candidate in this year's contest who dares to go there.

"The Affordable Care Act is a majestic step forward for this country -- for the only nation that hasn't made health care a human right yet. But luckily I'm in a state that's able to take even a bigger step," Berwick told TPM in an interview. "And a single payer option -- even if the country is not ready for it, I think Massachusetts is ready and it's worth exploring."

A political novice, Berwick is an underdog candidate for the Democratic nomination in the 2014 elections -- the most outspoken progressive in the race. A pediatrician, Harvard health policy professor and former health care executive, his talent for -- and obsession with -- health management caught the eye of President Barack Obama, who in 2010 appointed him to be the Administrator of the Center for Medicare & Medicaid Services, which was tasked with getting Obamacare off the ground in its infancy. Berwick left in December 2011, after his recess appointment expired and Senate Republicans refused to confirm him.

"I've been looking hard at the Massachusetts budget and I've become more aware than ever of how the rising costs of health care are taking opportunity away from other investments," he said. "I saw it in Washington, and I see it in Massachusetts. We need to find money for transportation, education, the social safety net. ... And so I feel a sense of urgency about getting costs under control without harming patients at all."

There are huge obstacles, as he acknowledges. Entrenched industry groups who prefer a multi-payer system. Insurance companies who would cease to exist. Conservatives who view such a system as an affront to economic freedom. Questionable support from the state legislature. Even though liberals across the country passionately support the idea, no state has set up a single payer system yet and no president has seriously considered it. Luckily for Berwick, Massachusetts is ahead of the curve on health care: In 2006, Gov. Mitt Romney set up the nation's first ever state-based universal health care system, which subsequently became the template for Obamacare.

Berwick and three other candidates vying for the Democratic nomination are getting crushed in the polls by Martha Coakley, the attorney general known nationally for her 2010 U.S. Senate campaign that failed spectacularly. She has the support of 56 percent of Democrats, according to a Suffolk University poll out this week. Berwick is a distant fourth place tie, with a measly 1 percent. (Worse yet, he's polling behind the top Republican candidate, Charlie Baker.) He refused to talk about Coakley, but pointed out that Elizabeth Warren was also relatively unknown early in her Senate campaign, and that Mitt Romney was also a political newbie. The primary is seven months away, on Sept. 9.

So far, his campaign says he's raised about $847,000 and spent $706,000. He touts endorsements from Massachusetts State Sen. Sonia Chang-Diaz (D) and Mass-Care, the state's campaign for single payer. Mass-Care's executive director Ture Turnbull said rising health care costs "are crippling the economy in Massachusetts" and harming families and clinicians. Berwick's spokesman, Joshua Cohen, predicted that "we'll start picking up more support soon."

"I would claim that I'm the boldest progressive in the race," Berwick told TPM. "We've not minced our words. I say what I believe. I'm the only candidate to support single payer. I'm the only candidate opposing that law that allows casinos in the state." He worries about being seen as the health-care-only candidate when it's not the top concern of Massachusetts residents -- 98 percent of whom have insurance -- and insists he'll also prioritize education reforms and "repairing our very flawed transportation system" if he becomes governor.

Berwick has the scars to show his liberal credentials. Former underlings at CMS lavishly praise him. He had a series of high-profile clashes with congressional Republicans in Washington, who forced him out because he once said nice things about the British health care system. They said it signaled his support for "rationing" -- a claim that Berwick vociferously denies.

"What did I learn? People took comments out of context and converted it into basically lies," he said. "They attributed to me ideas I didn't have, and they did it for distortion. It happened more than I thought. But it never for a moment changed what I believe."