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President Obama’s plan to give all Americans the option of a government-run health insurance plan got a frigid reception in June from the American Medical Association, the nation’s leading lobbying group for physicians. Offering a public plan would “restrict patient choice by driving out private insurers,” the AMA warned in a statement before Obama appeared before the group. After hearing Obama speak, the AMA backtracked a bit from outright opposition, but it was clearly not encouraging any health-care reform that includes a public option.

On May 13, I lingered in Upper Senate Park, just north of the U.S. Capitol, hearing New Orleans jazz coming from down Constitution Avenue. Then I saw the brass band leading a lively procession of hundreds of nurses, other medical professionals and patient advocates. It was the National RN Day of Action, a lobby day for several state nurses’ associations—among the most ardent proponents of single-payer health care.

Longtime advocates of single-payer insurance like me are thrilled, anxious and deflated simultaneously by the state of the debate on health-care reform. The debate that we wanted has finally come, and it is coming with a legislative rush, but the plan that we wanted is being excluded from consideration. Should we hold out for the real thing, or get behind the best politically possible thing?

I am for doing both: Standing up for single-payer without holding out for it exclusively; supporting a public option without denying its limitations; and hoping that a good public plan will lead eventually to real national health insurance.