After spending years voting and pledging to repeal the Affordable Care Act (ACA), when the time finally came for the Republicans to replace President Obama’s landmark health-care legislation, they hopelessly failed. Their plan would have led to skyrocketing premiums for the elderly and taken away the insurance of more than 20 million people. Only 17 percent of the public supported the GOP plan, and it never even made it to a vote.

Still, it’s clear that our current health-care model isn’t working. At 16.9 percent, the United States is an outlier in health-care expenditure as a percentage of the GDP — the second highest being Switzerland, at 11.5 percent—and the only country not to have a highly regulated universal system. There’s reason to believe that universal health care could significantly reduce total spending on health care. And Democrats and progressives need to proactively present an alternative to the ACA.

California may be the state to show the way forward. In February, Senate Bill 562 was introduced to create a single-payer health-care system that would cover all 38 million Californians. The program would eliminate copays and insurance deductibles, and “inpatient, outpatient, emergency care, dental, vision, mental health and nursing home care” would be covered. The funding specifics have not yet been provided, but this is still a significant step forward in the fight for universal health coverage.

Though governor Jerry Brown argued that single-payer would be unaffordable because California’s current system consumes 18 percent of the state’s GDP, California still has other prospects for universal health care. Gavin Newsom has promised to implement it if he becomes governor in 2018, though he’s not advocating a single-payer system. He plans to build off of Healthy San Francisco, a program he implemented as mayor in 2007. This program would fill in the gaps of the ACA by paying for those who do not have insurance, allowing them to visit community health centers and public hospitals for primary and preventative care, which has reduced overall health spending in San Francisco by catching severe diseases early and avoiding costly emergency-room visits.

Canada’s single-payer health-care system did not begin as a national program but was pioneered in the province of Saskatchewan.

While there isn’t any guarantee of single-payer happening in California, the state is taking steps in the right direction toward the goal of universal coverage. Americans need not imagine how this may occur but could look to their northern neighbor for an example.

How Single-Payer Took Hold in Canada

Canada’s single-payer health-care system did not begin as a national program but was pioneered in the province of Saskatchewan. The development of universal health care took place from the mid-1940s to the 1960s and was accompanied by constant scaremongering from right-wing forces that warned that any attempt to provide government health insurance was a communist plot to take away individual freedom. They used the term “socialized medicine,” a phrase used in US health-care debates to this day. However, Canadians weren’t buying the fear campaign, as 80 percent supported a “government-funded health plan” as early as 1944.

Significant credit for Canada’s single-payer health-care system belongs to Tommy Douglas, the left-wing leader of the Co-operative Commonwealth Federation (CCF) in Saskatchewan, and later the founding leader of the federal New Democratic Party (NDP). Canadians are not ignorant about what he did, considering he was voted the Greatest Canadian in 2004 for his role in establishing universal health care.

Douglas rolled out provincial hospital insurance in 1947. When the federal government responded with a plan to provide 50 percent of the funding for public hospital insurance in 1957, Douglas promised to expand provincial insurance plans to include medical services. Despite fierce opposition from doctors and medical associations, the CCF won 38 of 54 seats and 41 percent of the popular vote. Legislation was passed in October 1961 for the new publicly funded medical insurance to begin on July 1, 1962.

“What most people who favour compulsory health insurance fail to realize that it is a Trojan horse. They fail to discern that under a superficially attractive exterior it hides the forces which will destroy their freedom of choice and import a full-fledged system of state medicine into their midst.” —William Anderson, Vice-President and Managing Director of North American Life Insurance, 1954

In 1961, doctors began holding rallies under the banner “Keep Our Doctors,” warning that many would move abroad if the government didn’t cancel its public insurance plan. On July 1, the doctors went on strike, but public opinion and the media were firmly against them. After some minor concessions, the doctors returned to work after only a few weeks of action. Around the same time, the Royal Commission on Health Services had been formed on the federal level, and the Medical Care Act was finally passed in 1966. The Medical Care Act provided funding to provinces that met the federal criteria for public health insurance: “universal, publicly administered, portable and comprehensive.” By 1971, all provinces had established systems that fit the criteria, meaning that less than 10 years after Saskatchewan had first adopted it, universal health care had been rolled out across the country, and every Canadian had public health insurance.

It Can Happen in the United States Too

Canadian universal health care began as a subnational initiative, but it expanded to the national level. The same could happen in the United States. This has already happened with the legalization of marijuana and could occur if California takes meaningful steps toward passing a universal health-care plan.

The legalization of marijuana is the culmination of measures taken over the course of several decades. Efforts at decriminalization began in the 1970s, followed by California’s legalization of medical marijuana in 1996. In 2012, voters in both Colorado and Washington approved ballot measures to legalize marijuana, and its legal sale began in 2014. A total of 28 states have now legalized medical marijuana. While the federal government has not adopted state policies in this instance, it is very clear that the actions of two states have set an example that others are following.

California could do the same with universal health care. As the Saskatchewan example shows, it’s better to start somewhere than to wait for the perfect conditions that allow its implementation. Douglas started with public hospital insurance and expanded it to medical insurance when he started receiving additional funding from the federal government.

Progressives should continue the fight for single-payer whenever the opportunity arises. They should support Bernie Sanders’s federal single-payer plan and any similar initiatives on the state level, but that also shouldn’t stop them from fighting to implement and improve Newsom’s plan if that can realistically be achieved in the near term. The passing of universal health care in California in 2018 would be an important win, one that could push policy and public opinion in favor of greater expansion, moving closer to the goal of extending coverage to every American.