As an intensive care physician, I’ve spent my career recognizing and treating critical conditions. And today, when I look at the Democratic Party — the one I’ve been a dedicated member of since even before I could vote — I see a party literally fighting for its life.

Last year, we Democrats suffered the most humiliating defeat in our history. In Pennsylvania, our presidential candidate lost to a felon and wannabe dictator, while downballot, we shed a three-term U.S. Senate seat, two congressional seats, the attorney general’s office, and more. Young people, a core constituency, shifted to the right in droves, while many more just decided it wasn’t worth the effort to vote at all.

Yet as we gear up for next year’s midterms, the party leaders who presided over this drubbing are already back, asking for your support like nothing much needs to change. It’s as if they believe some tinkering around the edges and a few more automated text messages asking for donations will make it better. It won’t.

While just being the Anti-Trump Party should be enough, it’s not. The painful truth is more and more Americans don’t see us as being on their side. They view Democrats as beholden to the same special interests as our opponents and only offering cautious adjustments to systems that stopped working for them a long time ago.

On too many issues, Democrats simply fail to acknowledge the magnitude of the problems Americans face. Take an issue close to my heart: the current crisis in U.S. healthcare. Right now, Democratic leaders are focused on stopping Trump’s grotesque cuts to Medicaid, a critically important effort and one I wholeheartedly support. But if Democrats think protecting legacy programs such as Medicaid is enough to win the hearts and minds of American voters, they are in for a disappointment.

Regular Americans are so angry with the system they cheer the cold-blooded murder of a healthcare executive, and millions of Americans with health insurance still find their coverage so inadequate they are one illness away from needing to launch a GoFundMe page.

Americans are desperate for big changes in healthcare, our tax system, campaign funding, and how we pay for higher education, to name just a few. But instead of championing things such as expanding the option of government-sponsored health insurance to everyone, fighting the hold of corporate power over American life, or reforming our corrupt campaign finance system, Democratic leaders mostly retreat to safer ground.

So, when Americans are left to choose between a party that doesn’t acknowledge their pain, and one that does but only offers to blow everything up, many choose the latter.

Unfortunately, Democrats’ problems won’t end with better policies; not while we as a party struggle to land on a moral vision of the future to compete with Trumpism. In politics, policies are like cargo and vision is the ship, and cargo goes nowhere without a ship to carry it. Sadly, as wrong and repulsive as Trumpism’s message often is, it’s a sleek and powerful ship built to carry a lot of freight.

Meanwhile, we Democrats — a coalition of many disparate voices — nearly 10 years into Trumpism, are still flailing around trying to craft our own vessel to stow our policies in. Here, I’ll admit, I don’ t have all the answers. But I know this: If Democrats want to go beyond eking out narrow victories across the state and country and instead want to win with margins we need to accomplish the big things this country needs to get done, we must unite behind a moral vision of where we want the country to go.

Lastly, Democrats need to rethink the way we talk. Engaging with people who disagree — both inside and outside the party — is crucial for us to grow. Politics cannot just be about preaching to the choir. And we can never afford to let dogma or labels stop us from building the coalition we need to move forward. While real philosophical differences exist in our party, reasonable and even inspiring ideas will come from everywhere.

The measuring stick for Democrats should not be where the idea came from, but whether it is offered honestly, without ties to secret handlers, and crafted to truly meet the moment.

For Democrats, the first eight months of a second Trump presidency have been sickening to watch, and it is far from over. While it is urgent to keep up the fight against Trump, we can’t do that effectively until our party is strong and healthy. Resuscitating the Democratic Party will take all of us, and the work must begin now.

David Oxman is an intensive care physician, a medical school professor and a candidate for the Democratic nomination for Congress in Pennsylvania’s 3rd Congressional District. For more information go to daveoxman.com.