Two years ago, if you had asked me about the prospects for a single payer health care system to be adopted in the United States, I would have said that there was essentially no chance in the foreseeable future. Single payer would be too expensive and too disruptive to both patients and providers. Even if you could cobble together a semi-functional legislative plan, the politics would never work. Short of catastrophe, there was no way it would ever happen.

But since the 2016 election, I have become slightly less confident in my assessment. I still think single payer in America is quite unlikely. Yet the possibility now strikes me as a little higher — if not in the near term, then a decade or three into the future. And the odds that some sort of hybrid quasi-single-payer system that significantly expands the role of government in the financing or provision of health care have increased even more.

The reason why I’ve changed my thinking is that over the last year or so Democrats and progressive activists have found a new energy in trying to make it happen. During the Democratic primary campaign, Bernie Sanders backed single payer to great effect, and has spent the summer working on a Medicare-for-all bill. Public support for single payer is rising this year. One new poll this month found that a majority of doctors are in favor.