FWIW I don't think that single-payer healthcare on the federal level is actually a realistic pathway to reform healthcare. There's too much gridlock for anything major like that to pass, and I don't think this will change for at least another decade.
State level feels much more doable. Not only that, but Canada did it that way - IIRC Saskatchewan did it first, it worked well for them, and those results entered political discourse in other provinces causing a domino effect of sorts. Then finally the feds jumped in to regulate the baseline and assist with money to help the poorer provinces keep up. But to this day, it's actually a voluntary arrangement that any province could leave at any point; it's just that even in Alberta ditching public healthcare is such a fringe extreme right position that no politician hoping to have a successful career would seriously contemplate it.
And ofc if you do it state by state, then it doesn't have to be single-payer everywhere, either. We could try that in states with a more socialized political culture, and e.g. the Swiss model in more conservative states, and maybe something like Germany's private non-profit healthcare coops elsewhere. I would probably prefer the latter for myself for the sake of decentralization.
State level feels much more doable. Not only that, but Canada did it that way - IIRC Saskatchewan did it first, it worked well for them, and those results entered political discourse in other provinces causing a domino effect of sorts. Then finally the feds jumped in to regulate the baseline and assist with money to help the poorer provinces keep up. But to this day, it's actually a voluntary arrangement that any province could leave at any point; it's just that even in Alberta ditching public healthcare is such a fringe extreme right position that no politician hoping to have a successful career would seriously contemplate it.
And ofc if you do it state by state, then it doesn't have to be single-payer everywhere, either. We could try that in states with a more socialized political culture, and e.g. the Swiss model in more conservative states, and maybe something like Germany's private non-profit healthcare coops elsewhere. I would probably prefer the latter for myself for the sake of decentralization.