Since Bernie Sanders made it a cornerstone of his 2016 presidential run, Medicare for All has become an increasingly popular and obvious demand. The system, which works by eliminating the private insurance market and relying on the government as the sole payer of health care costs, has been used by many other countries for decades.

Americans, by contrast, pay costly monthly premiums to private insurance companies and still can’t even use their benefits because of outrageously high deductibles. And if you’re fortunate enough to receive decent health insurance through your employer, you are left vulnerable to an otherwise hostile workplace, since keeping your health care depends on keeping your boss happy.

The failure of Obamacare to rein in costs and reliably expand coverage has led people to a logical conclusion: why not just get rid of private insurance altogether? Unfortunately, under the present administration, a federal improved Medicare for All program is unattainable  — just recently, President Trump felt compelled to attack Medicare for All in a USA Today op-ed. As a result, many have retreated to state legislation. But state single-payer efforts face a number of major challenges. One would be navigating the existing, fragmented federal health care system.