I think the single-payer movement should try to make a push in certain states
States that have shown signs of certain strains of leftism, states that seem to welcome an expanded welfare state.
Looking over how everything went down last night, I find a surprising degree of comfort in ballot initiatives that passed and didn't pass. Minnesota didn't ban gay marriage. Washington and Maryland and Maine all legalized it. Massachusetts permitted medical marijuana. Washington and Colorado legalized marijuana outright, putting them to the left of the Netherlands on drug policy. When was the last time a part of the US was to the left of anywhere else, on anything?
The point to take from all this, from my perspective, is that at least in parts of the country the common people are enough to the left that they would probably welcome real universal health care. Places like Massachusetts- wouldn't it be great to pass single-payer in the state where the Romneycare/Obamacare mess got started? Places like Vermont- where Peter Shumlin of sort-of-single-payer fame won reelection. Places like Washington, Oregon, Maine, Maryland.
Obamacare throws a spanner in the works, true, but I feel like this is something worth pushing for anyway. It's like the marijuana legalizations: the federal government may say you can't do it, but common decency says you should, and at our state levels we should fight for common decency above all else.
Just my perspective.