Let’s keep things simple. The Sanders campaign should just say that the road to single payer depends on how many Democrats we can elect—and when—and that it might take more than one election to get rid of a sufficient number of Republicans. He should say that frankly, he thinks the reality is that he’d be lucky to be able to get a progressive enough Congress in his first term and that he can’t do this alone.
The important thing is to gradually build on the accomplishment of ACA.
But universal healthcare—a Medicare for all system—would be a very clear thing to campaign on in the next couple of elections. All you have to do is ask people to ask their parents (or grandparents) how they like their Medicare and build a movement behind that.
He could also say that the goal is single-payer and there are several routes. He would propose, as a first step, universal, single payer for pregnant women, and dare Republicans to vote against the unborn. If they oppose it, crucify them with that in the 2018 elections. The ads write themselves. Most people with common sense and any sense of decency want babies to be born healthy.
Then propose to extend Medicare to children under 18 because children have no choice about their medical care or how much money they make and should not be deprived of treatment because their parents can’t afford it.
In both cases, the system would be protecting the most vulnerable population first and trying to ensure everyone gets a healthy start in life.
And people under 18 are relatively healthy, so the cost of insuring them would be lower.
Furthermore, covering people under 18 offers an opportunity to move away from the fee-for-service model and towards more of a subscription model in which medical practices would be paid a certain amount for each subscribed patient and take responsibility for preventive care to minimize treatment costs.
Paying for the initial stages could be done partly via a small increase in the payroll tax, but the proposal should also be made in tandem with an increase in the minimum wage to $15/hour. Both Social Security and Medicare would be in better shape financially if wages had been going up in line with productivity, which they did before the Republicans’ successful assault on unions, starting in the 1980s. Increasing the minimum wage would reduce the amount that the payroll tax would have to go up. The system could also be paid for out of general revenue for a transition period until we have full enough employment at high enough wages. Surely we can cut out an aircraft carrier battle group or two.