But while other nations have adopted such systems, it’s been impossible to establish in the United States. Vermont enacted the nation’s first such system in 2011, but later abandoned it because it would have cost too much.

In California, voters overwhelmingly rejected a healthcare universal system in a 1994 ballot initiative. Former Republican Gov. Arnold Schwarzenegger twice vetoed similar legislation in the 2000s. And a 2017 proposal stalled in the state Assembly.

The biggest hurdle is cost. A study of a 2017 proposal for universal healthcare in California estimated it would cost $331 billion, which is about $356 billion today when adjusted for inflation. Meanwhile, California is expected to account for about $517 billion in healthcare spending this year, with the largest chunk coming from employers and households, according to an analysis by a commission established by Gov. Gavin Newsom to study universal healthcare.

For comparison, California’s entire state operating budget — which pays for things like schools, courts, roads and bridges and other important services — is about $262 billion this year.

To pay for the plan, Democrats had introduced a separate bill that would impose hefty new income taxes on businesses and individuals, which fueled much of the opposition to the plan.

“Today’s vote in the Assembly providers was a vote to protect their constituents from higher taxes and chaos in our healthcare system,” said Ned Wigglesworth, spokesperson for Protect California Health Care, a coalition of healthcare opposed to the bill.

Supporters say consumers are already paying exorbitant amounts for healthcare, saying a single-payer system would save money by eliminating deductibles, copays and expensive monthly insurance premiums.

Both bills are likely now dead for the year. But Kalra appeared to indicate he would try again next year, saying “this is only a pause for the single-payer movement.”

He’ll have to navigate a new Legislature next year following the midterm elections that will see lots of turnover in the state Assembly because of term limits. Assembly Speaker Anthony Rendon, a Democrat from the Los Angeles area who will be termed out in 2024, said he was “deeply disappointed” Kalra did not call the bill for a vote on Monday.

“I support single-payer and fully intended to vote yes on this bill,” Rendon said. “With time, we will have better and more successful legislation to bring us closer to this goal. I expect more and more of my colleagues to sign on, so we can make California a healthcare justice leader.”

Republicans, meanwhile, seemed to welcome Democrats’ persistence.

“The fact that a proposal for a government takeover of our state’s entire healthcare system even made it this far shows just how out of touch the Democratic party is from the needs of everyday Californians,” Assembly Republican Leader Marie Waldron said.