Liberals can scream, gnash their teeth, protest and report horror stories under the current US health care system until they're blue in the face and it isn't going to change the fact that single-payer IS off-the-table. The broad-based consensus that the US health care system is broken IS not a consensus for single-payer. Add up the numbers of those who function well enough in the existing system, and it's easy enough to see that they are in the majority and they aren't about to risk what they've got for an undefined and untried alternative. If GWB could get a 90% approval rating for yelling into a bullhorn, exactly how difficult would it be for the health insurance companies to activate majority opposition to single-payer? And please spare me the claim that Medicare is a functioning single-payer system. It's quasi-single payer and it's not functioning.
First, every worker and employer subsidizes Medicare (2.9% of all wages – 3.9 workerspaying in for each Medicare recipient). That's a whole lot of subsidy. Second, payment for services are below market costs – if not for the cost shifting by providers from Medicare patients to those with private health insurance, it would have collapsed long ago. Even with the cost shifting subsidy, the program is expensive (and Medicare Part C (Clinton) and D (Bush) made it a whole lot more expensive). Third, end of life medical expenses eat up a disproportionate share of Medicare costs – and these costs cannot be contained as long as we believe that more medical intervention is better than less.
Single-payer advocates (and I include myself until fairly recently) assert that if the pot of money that goes to health insurance companies went to Medicare-for-all that everybody could have high quality health care. Two errors in this assessment. First that "pot of money" would be less – far less. Employers and employees want health insurance that costs less. If private insurance costs the same as Medicare-for-all, employers and employees will choose private insurance. If those employers could reduce their costs by 25% with Medicare-for-all, they would take it, but then all the money going to health insurance companies disappears (along with the jobs at those companies).
Collecting money from the under/uninsured and their employers would put more money into the pot, but neither can afford anything close to what it would cost. Most would struggle to meet Medicare premiums and co-pays, and that is only a small portion of what the "single-payer" Medicare costs. We could subsidize the remainder through general revenues, another sin tax (internet gambling and porn?) or some other regressive tax. Do that and the political backlash will be intense.
All sides on this issue appeal to the public by promising "CHOICE." As Henry Ford pointed out long ago – any color you want as long as it's black – choice costs more. Sillier still is the notion that the average American has the ability to assess the quality of medical care and make a rational choice. 60% of adult Americans don't accept the theory of evolution, for god's sake, and approximately half of voters chose GWB not once but twice. A smooth talking snake oil salesman would appeal to more of them than a curt, competent doctor or nurse would.
The third leg in the US dysfunctional health care system is the providers. For the most part they are silent about their contribution to this mess. How the industry has kept supply below demand. Catered to those who can pay for expensive procedures and interventions. The one field where supply-side economics has merit – medicine – has been the one that supply-siders never mention. Instead we get "productivity" and wringing out excess costs claptrap instead of training enough doctors, nurses, etc. Not enough providers = rationed health care. With the help of the insurance companies and government programs for the old, disabled and poor, the rationing remains hidden, covert. The problem becomes not enough affordable health insurance instead of what it really is: not enough affordable health care.
As a change agent, Obama gets a D. (GWB actually scored higher on that measure – remember, change doesn't equal good.) He's got the war hawks still running foreign policy, the neo-liberals still running the economy and same ole- same ole charged with fixing health care. The cool thing for Obama is that whatever his gang cooks up for health care (more private insurance, more federal subsidies for insurance, etc.), he'll have completed his two terms before it becomes obvious that the health care system is as bad or worse than it was before he took office just as it has been for every President after LBJ, regardless if they did something or nothing.
There is no panacea for what ails the US health care system. No quick fix. Tweaking what currently exists and dumping more money (lots more money) into it is like propping Wall Street. These institutions are rotten – and yet, too big to fail. At least as long as we refuse to invest in and begin building rational, functional alternatives to them. And, "Yes, We Can."