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Emerging from the smoking, twisted rubble of Paul Ryan and Donald Trump’s attempt to obliterate the Affordable Care Act is an increasingly clear consensus among Americans that health care for all is a government responsibility. Just listen to Louisiana Republican Senator Bill Cassidy: “There’s a widespread recognition that the federal government, Congress, has created the right for every American to have health care.”

But also arising from the ruins is something even more startling: a revived and vigorous movement for a “Medicare for All” health-care system that would go far beyond incremental change and seek to displace the profit-maximizing insurers who now dominate U.S. health care. From political leaders like Senator Bernie Sanders, to major organizations, to groups of ordinary citizens mobilized to defend the ACA, a popular cry for a nonprofit, human-centered health-care system is arising.

Sanders is rolling out a new Medicare for All bill.

“We have got to have the guts to take on the insurance companies and the drug companies and move forward to a Medicare-for-all, single-payer program. I will be introducing legislation shortly to do that,” he announced. “It is a common-sense proposal, and I think once the American people understand it, we can go forward with it.”

Sanders and other advocates, including Senator Elizabeth Warren, argue that only a large-scale movement can beat back Republican efforts to sabotage the ACA and begin moving America toward the health-care alternative it needs. And, as David Leonhardt noted in The New York Times,“It’s not worth expanding health coverage in a conservative-friendly way, because Republican leaders won’t support it anyway.”

Far more appealing is a health-care plan that fully addresses the new reality of “unaffordable under-insurance” that plagues people both inside and outside the ACA coverage. While Trump, Ryan, and other Republicans worked cynically to generate resentment and division, Americans now see themselves together as victims of unpayable premiums, deductibles and copays imposed by for-profit insurers. People are more open than ever to hearing an appeal about the expansion of Medicare for All.

Pervasive problems, both for those with private insurance and the twenty-eight million Americans still lacking coverage even with the ACA’s help, explain the hunger for reform.

More than 30 percent of health-care spending is siphoned away by insurance corporation profits, administrative overhead, and marketing. Recovering this money would create an enormous revenue stream to help cover the vast army of the uninsured and improve the surprisingly poor outcomes from the expensive U.S. health system. (Health care in the United States costs 2.5 times as much times per capita as in other nations. Yet America ranked fiftieth in health-care efficiency among fifty-five nations on Bloomberg’s health efficiency index.)

The connection between an unfair health system and an increasingly unequal economy is becoming painfully obvious, observes Nobel-Prize winning scientist Angus Deaton, who has written that the American health care system is "exquisitely designed as an inequality machine, commanding an ever-larger share of G.D.P. and funneling resources to the top of the income distribution.”

Polling data indicates strong majority support for a single-payer system built around nonprofit insurance entities. Well over half of Americans want to replace Obamacare with a single-payer system. That figure, amazingly, includes 41 percent of Republicans and Republican-leaning independents—even though the wording of the question specifies that the program would be ‘federally funded.’

But reform will not happen without a prolonged and bitter struggle. Think back to 1948, when President Harry Truman began his campaign for universal health care with a solid majority of the public behind him. The fervent assault of the American Medical Association against “socialized medicine”—waged with the assistance of all their allies in the medical industry—stopped the Truman campaign in its tracks. Since then, the insurance industry, Big Pharma, and medical equipment makers and assorted firms have only metastasized in size and lobbying power.

Still, a growing number of doctors and hospital administrators are recognizing the barrier to America’s health imposed by insurance bureaucracy and profit-mindedness. The profound social crisis afflicting working class people aged forty-five to sixty-four—facing insecure, low-paid jobs without health insurance while suffering social uncertainty—will intensify the outcry to expand Medicare to cover this group. (During the ACA debate, Democrats bound to the insurers shamefully blocked this humane and sensible move.)

Moreover, the number of states advancing “Medicare for All” initiatives is growing, including California and New York. The United States could see a similar pattern to Canada, where. provinces established immensely popular single-payer systems before a national plan was adopted.

Finally, the establishment of a “public option”—for individuals unable to find satisfactory insurance on the private market—would create another small source of momentum for Medicare for All.

In short, while the battle for Medicare for All is not likely be quick or easy, we have major opportunities to seek improvements in health care that will widen the already massive base of support for a humane, nonprofit system.