It was a big political discussion in a very small room.

“Medicare for all” got its first congressional hearing on Tuesday, albeit in one of the House’s tightest meeting rooms, in an area of the Capitol off limits to the scores of people who assembled in Washington to show support.

The idea of a single government health care system for all Americans has been treated with extreme caution by the Democratic leadership, which has stressed more modest improvements to the current health law. On Tuesday, Speaker Nancy Pelosi’s office was pointing to the bills moving through the House Judiciary Committee that could lower the prices of prescription drugs.

Yet here was Ms. Pelosi herself, escorting a supporter of Medicare for all, Ady Barkan, to the House Rules Committee meeting. Mr. Barkan, who has long advocated for health care expansion, has the degenerative neural disease amyotrophic lateral sclerosis and used a computer to help him speak. He proved a powerful presence.

“We have so little time together, and yet our system forces us to waste it with bills and bureaucracy,” he told the committee in his opening statement, noting that the fast progress of his disease had impressed upon him the urgency of reform. “That is why I am here today, urging you to build a more rational, fair, efficient and effective system.”

Ostensibly the hearing was to discuss a recent bill introduced by Representative Pramila Jayapal, Democrat of Washington, that would move the nation to a single, government insurer in two years.

Although the bill has more than 100 Democratic co-sponsors in the House, it is not expected to advance even to the House floor. Led by Jim McGovern of Massachusetts, a Medicare for all supporter, the hearing allowed the idea to have its moment without necessarily moving it any closer to becoming law.

And yet, despite its largely symbolic nature, the debate over the bill was substantive. Members of the committee, which does not specialize in health policy, courteously asked questions about the effects of a single-payer system on national health spending, on hospital finances and on patients’ access to care.

The relatively small committee is typically the last stop for legislation as it reaches a final vote, not the setting for an initial hearing on policy legislation. “I don’t think we could squeeze anyone else in this room,” Mr. McGovern said in his opening remarks.

More expertise may be coming, and a bigger room. Not long before the end of the five-hour hearing, Richard Neal of Massachusetts, the chairman of the House Ways and Means Committee, told the House Progressive Caucus that he would also lead a hearing on Medicare for all proposals, though not necessarily a formal consideration of Ms. Jayapal’s bill. The House Budget Committee, which does not have primary jurisdiction over health care legislation, will also hold a hearing next month.

Ms. Jayapal and other single-payer enthusiasts cheered the development as momentum for their proposal. But a more mainstream consideration of Medicare for all may hold peril for some Democrats. Republicans, who have lost political ground on health care since their failed efforts to repeal and replace Obamacare in 2017, see advantage in opposing Medicare for all.

Tuesday’s debate reflected the divisions that make a major overhaul of the health care system politically challenging. While Mr. McGovern was clear about his support for the Jayapal bill, other Democrats on the committee were more circumspect.

Donna Shalala, a freshman congresswoman from Florida, who was the health and human services secretary in the Clinton administration, was wary about the measure’s ambitious time frame. “I could build this system,” she said. “I don’t think I could do it in two years.”

But others expressed optimism about building broader support for the idea. “I am fascinated by how we are going to go through this process and get everyone on board,” said Jamie Raskin, Democrat of Maryland.

Republicans on the committee made clear they had deeper concerns, highlighting the ways the bill would eliminate employer insurance, provide coverage to undocumented immigrants, raise taxes or expand public funding for abortion, all possible attack lines they may use in their 2020 campaigns.

“Even if you like your plan, you really can’t keep it,” said Tom Cole, of Oklahoma, the ranking member of the committee, jabbing at President Obama’s breached promise that the Affordable Care Act would not disrupt anyone’s existing health insurance. Medicare for all would do so explicitly.

“It is a frightening bill to me,” said Michael Burgess, a congressman from Texas and a physician, as he speculated about how a government system might restrict access to certain treatments.

Yet the hearing — and the prospective hearing by the Ways and Means committee — also reflected Medicare for all’s progress from a fringe view to one firmly within the Democratic Party mainstream. Ms. Jayapal sat in the room beside Debbie Dingell of Michigan, whose husband, John Dingell, was one of the country’s most forceful supporters for a single-payer health care system during his decades in Congress. (He died in February.) She is a bill co-sponsor.

“I know this is a politically hazardous topic to go down the road on,” said Mr. McGovern, near the end of the hearing. “But we have to do it.”

Margot Sanger-Katz is a domestic correspondent and writes about health care for The Upshot. She was previously a reporter at National Journal and The Concord Monitor and an editor at Legal Affairs and the Yale Alumni Magazine. @sangerkatz • Facebook

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