Some men see things as they are, and ask why. I dream of things that never were, and ask why not?

And sometimes there's an answer as to "why not."

Why don't we have flying cars or robot housekeepers or teleporters or moon colonies, long dreamt of in science fiction? Because those things present technical obstacles that we can't yet surmount. Why do we still have crimes like murder, even though theoretically there's no reason we couldn't eliminate them if everyone behaved? Because society doesn't have a way to eliminate crime.

Part of getting to the things that never were is figuring out "why not?". If you want to bring a new thing into being, you have to figure out why it hasn't yet happened and change it.

If you think we don't have single-payer health insurance only because of evil insurance companies, then there's an obvious political solution. Name them as the enemy, cultivate righteous anger against them, and get the electeds willing to shaft the insurers. That's also great for getting elected, which I think is another reason why progressives love to make the argument this way.

But to actually get it passed? You need to solve for the massive constituencies that aren't the evil insurance companies that will be affected by this change. You need to solve for the impact on public sector union employees and retirees who haven't budgeted for a VAT or the fact that existing employer contributions can't cover even half the costs of this program. And to do that, you need to build buy-in from those groups - and you can't get it if you keep pretending that the reason we pay more for health care here is because of inefficiencies in the system of payment, and not because we actually spend more on the health care services themselves (price and amount) than in every other country.