The prospect of bold government action appears to be accepted among players across the ideological and political spectrum, including those who opposed the idea in the 1990s.
After decades of failed efforts to reshape the nation's healthcare system, a consensus appears to be emerging in Washington about how to achieve the elusive goal of providing medical insurance to all Americans.
The answer, say leading groups of businesses, hospitals, doctors, labor unions and insurance companies -- as well as senior lawmakers on Capitol Hill and members of the new Obama administration -- is unprecedented government intervention to create a system of universal protection.
At the same time, those groups, which span the ideological and political spectrum, largely have agreed to preserve the employer-based system through which most Americans get their health insurance.
The idea of a federal, single-payer system patterned on those in Europe and Canada, long a dream of the political left, is now virtually off the table.
Rejected as well is the traditionally conservative concept, championed by Sen. John McCain (R-Ariz.) during the presidential campaign, of reforming healthcare mainly by giving incentives for more Americans to buy insurance on their own.
There also is a widespread understanding that any expansion of coverage must be accompanied by aggressive efforts to bring down costs and reward quality care. And key players in the healthcare debate increasingly back a massive investment of taxpayer money for healthcare reform despite the burgeoning budget deficits.
Beyond those areas of basic agreement, the details of what would be one of the most momentous changes in domestic policy since World War II remain vague.
As a presidential candidate, Barack Obama embraced both expanded insurance coverage and preservation of the job-centered system, but since he won the White House he has provided few specifics about his plans once he takes office.
Disagreements over specifics could again lead to a stalemate. Even the most sanguine advocates of sweeping reform concede that difficult negotiations lie ahead.
But what is taking shape is a debate very different from previous discussions about what America's healthcare system should look like.
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