Healthcare incrementalism: a practical approach
Let's talk about a fall back position. Let's say the climate in the US will not support an all-at-once single payer system. OK. What would work?
Chuck Pennacchio argues for a state by state approach. If we can pass single payer systems in a few states, people will see its superiority. It seems that is how it was adopted in Canada, first Saskatchewan passed a single payer, then the Saskatchewan Premiere (or whatever they are called, I'm just an amateur blogger) got elected PM of Canada and passed a national system. So a states first approach does make sense.
There is single payer legislation pending in California, Ohio, and other states. We just need it to pass in one state for it's virtues to be obvious.
For that to happen we need to insist that any federal legislation not preclude the states implementing a single payer solution if they want to.
For example, the state of Maine wanted their state Medicare and Medicaid system to bargain for prescription drugs. The Pharmaceuticals and AARP sued the state of Maine and took it all the way to the US Supreme Court. The court ruled in Maine's favor and that very day Medicare part D was introduced complete with the provision that states could not bargain for prescription drugs. There is a very real danger that a federally passed health care system will include provisions that prohibit states from implementing a single payer system. At an absolute minimum we must prevent that from happening.