So the reality is that, so long as Republicans remain committed to sabotaging Democratic health proposals, there are few good ways to get to single-payer. And there are many ways to get there that risk destroying political support for the entire project. Transforming the American health care system requires a sustained commitment over several years. But the American system of government gives a determined opposition many opportunities to undermine such a long-term project.

But that also does not necessarily mean that the project is doomed. It can potentially be done in steps. They will just be slow steps, implemented over a long time, and punctuated by periods of Republican rule that could take the project several steps backwards.

This first appeared in Think Progress here. 

Image: Reuters.