Does pointing out the possibility of incremental progress mean giving up on a truly universal system? No. By all means let’s make something more ambitious, such as Medicare for all, a long-term goal. But this goal shouldn’t stand in the way of policies that would immediately benefit millions of Americans, and save thousands of lives.

And while we debate the ideal health system, we mustn’t forget that Trump and his allies are as determined as ever to undo the progress we’ve made.

It’s true that so far repeated Republican attempts to destroy the Affordable Care Act have failed. In 2012 the Supreme Court rejected claims that the whole law was unconstitutional. In 2017 a Republican-controlled Congress narrowly failed to repeal Obamacare. And a variety of narrower efforts to undermine health reform and send insurance markets into a “death spiral” have fallen short: Markets seem to have stabilized, and one by one, states that initially rejected Medicaid expansion have been relenting.

But the people who want to take away your health care haven’t given up.

The latest attempt is a lawsuit claiming that the 2017 tax cut, which reduced the penalty for not having insurance to $0, somehow made the entire Affordable Care Act unconstitutional. It’s a ludicrous claim, both in terms of substance — would the law suddenly become constitutional if the penalty were a penny? — and because it’s clear that this was not legislators’ intention.

But the Trump administration has joined the suit and a partisan Republican judge has indeed ruled that the A.C.A. as a whole should be struck down.

Clearly, this case is headed for the Supreme Court. But Trump doesn’t want it heard until after the election.

Why does Trump want to leave this court case hanging? Partly because his side would probably lose. As I said, the lawsuit is ludicrous, although, given the partisanship of Republican-appointed judges, it might prevail anyway.