Though polling does not reflect an outpouring of love for private insurance, it is the devil Americans know. “There’s fear of change and comfort with what’s known, a bias toward the status quo, and it’s hard to quantify that,” says Topher Spiro, the Center for American Progress’s vice president for health policy. “There’s a real psychological issue that’s appropriate for policymakers to consider. I don’t think the people like us who are putting forth multipayer universal systems are doing so because we think insurers have some sort of superior efficiency or can improve the quality of care. It’s really a concern about how we get there the quickest in terms of political viability and with a minimum of disruption.”

Single-payer advocates play down the difficulty of transitioning into a government-run health care system. As Sanders puts it: “You have Medicare, a popular system that millions of people are already in. It seems to me the easiest way forward to get to universal care is to expand what’s already a popular system. I find it really amazing that people think this isn’t doable when back in 1965 they did Medicare without the technology we have today, and they were able to sign up 19 million people. So of course we can do it.”

But while the Republican efforts to gut Obamacare have bolstered support for a more ambitious health care policy, they have also clearly illustrated one potential downside of such a policy. “Medicare cuts are in Trump’s budget,” Tanden says. “If you’re worried about a Trump administration now, just imagine if the government has control of everyone’s health care. And I say that as a big-government liberal.”