The fact that health care costs in America are double, per capita, of what they are in any other country means that Americans, on average, are materially hurt by the current system. A universal streamlined system would materially benefit most Americans.

Sure, there are some systems that would do that, at least in theory. But they would all hurt medical providers. They spend less money on health care by spending less money on health care. Yes, they also spend some less money on health care administration - but the bulk of the difference is that they spend less money on health care. Most Americans would benefit from that, because most Americans aren't health care providers. But enough of them are health care providers that any system that could actually cut health care spending - actually cut health care spending - would be DOA in our system.

Which is why I'm deeply skeptical of the idea that even a single-payer system in the U.S. would be implemented in a way that it would actually reduce health care spending. It's not what we've seen with Medicare, after all. Our per capita health expenditures for seniors are also exactly double what other countries pay, despite that being a single-payer system.

Most of us here are focused on what needs to happen to make things better. You’re focused on how the entrenched interests can prevent that from happening.

I guess my point is that we're focused on the same thing - I just think that your "most of us" are missing what needs to happen in order to make things better. Fighting the wrong fight - or at least, naming an incomplete list of obstacles. Sure, insurance companies will always fight to protect their rice bowl. But medical providers and unions are also potent barriers to single-payer systems. They also are fighting to protect their rice bowl, and they're far more potent enemies of single-payer than insurance companies.

I mean, the most simplistic version of the case - putting it at the feet of insurance companies - just doesn't make any sense, given how all of the blue states have failed to crack this nut. Yes, insurance companies have some power, especially at the federal level. But that can't explain the failure of single-payer systems in states like New York and California and Vermont. Insurance companies just don't have that much juice in those jurisdictions, and Democrats have strong majorities in them up and down the level. What's blocking them are medical providers and unions. Well, the unions other than medical provider unions, who I suspect are much more inclined to my cynical take on the spending patterns under single-payer systems than your more optimistic view.