What I ultimately would like to accomplish is not going to happen right now. We have Republicans controlling the House. And many of the views that I hold, including Medicare for All — I think if we had a vote tomorrow, we’d get 15 to 20 votes in the Senate and would not win in the House. I realize that. But I happen to believe our current health care system is dysfunctional.

He's just pragmatically saying it needs to pass congress and it won't pass congress as congress is right now.
A reminder that the more we work to elect people to congress who will pass this, the more realistic it is that we can pass it.