I suspect nothing is possible in US on the federal level because of the lack of consensus.
But e.g. the Canadian (single-payer!) system is bottom-up - it originated with the provinces and is still run mostly by them, with the feds getting into the game relatively late and focusing mostly on funding and interoperability of the provincial systems. In theory, any Canadian province can withdraw from that system and run its healthcare however it sees fit, including a fully private system - it's just that it's a political non-starter even in the most conservative ones.
It's not clear to me why the same approach hasn't been tried more broadly in US, not even in deep blue states. All the focus is on the federal level, where it gets the most pushback, and where the party deadlock is the worst.
But e.g. the Canadian (single-payer!) system is bottom-up - it originated with the provinces and is still run mostly by them, with the feds getting into the game relatively late and focusing mostly on funding and interoperability of the provincial systems. In theory, any Canadian province can withdraw from that system and run its healthcare however it sees fit, including a fully private system - it's just that it's a political non-starter even in the most conservative ones.
It's not clear to me why the same approach hasn't been tried more broadly in US, not even in deep blue states. All the focus is on the federal level, where it gets the most pushback, and where the party deadlock is the worst.