Right now, there is a strange level of buzz around the Democratic Party starting to coalesce around single-payer healthcare. It won't happen, or at least, it won't happen any time in the remotely near future.
Who is pushing this little pipe dream? None other than one of my favorite punching bags... Bernie Sanders! Let's all take a moment to remember the idiocy of his campaign platform from 2016. Yes, he seriously pushed this nonsense: pass a constitutional amendment allowing Congress to restrict campaign spending in order to over-ride Citizens United, and then everything will fall into place. Single-payer, equality for everyone... kumbaya, my lord, kumbaya! Do you believe that the only reason Ted Cruz opposes single-payer healthcare is that he is bought off by big-whatever? No? Congratulations. You are smarter than Bernie Sanders.
And that makes my point for me. Some history...
Democrats got Obamacare passed in 2010 after pushing for something like universal healthcare for half a century. Truman started it. Yup, Truman. He got bupkis. Democrats kept pushing, and while they got Medicare for the old folks, and Medicaid for the poorest with a lot of state control under LBJ, that left big gaps. The closest they really came was when Nixon offered a deal for a relatively expansive employer mandate in 1971. Ted Kennedy turned that deal down, thinking he could do better. Ted Kennedy later claimed it was one of his worst mistakes. I guess murdering a woman in a drunk driving accident should rank up there too, but hey, who's counting?
Anyway, after '71, it wasn't until 1993 that the Democrats really got another shot. That... didn't work out, but the Clintons took some inspiration from Nixon's '71 offer as a starting point. Of course, the GOP by then was having none of it. (If you have read John Gilmour's Strategic Disagreement, this should sound like "pursuit and avoidance"...) So, they turned to a little shop called the Heritage Foundation to cook up a new plan. That plan was built around an individual mandate to buy health insurance, with subsidies for those who couldn't afford it, and some regulations, and blah, blah, blah. Democrats weren't having it, but a Massachusetts Governor took it and ran, and then...
In 2008, the election gave the Democrats the White House, House, and Senate, and after Arlen Specter switched parties, they had a filibuster-proof majority in the Senate, allowing them just enough votes to do something. They started with the Heritage Foundation/Republican Massachusetts plan. First, they added a "public option," and then immediately got rid of that to pacify the moderate wing of the party, and even then, they barely passed it.
That took half a century, and even then, the Democrats wound up passing the GOP's last offer, or at least something based on it.
Single-payer ain't happenin'.
1) Democrats need unified government to do anything. That's rare. They had two years under Clinton, and couldn't manage it. They had two years under Obama, and only barely managed Obamacare. Those were 14 years apart.
2) The House map is a "yuge" obstacle here.
3) Senate rules are a "yuge" obstacle, unless the Dems were to go nuclear.
4) Some Democrats talk big, but tend to get scared when they start to see the public backlash. They couldn't keep it together in '93 and '94. The 2010 election was the biggest landslide election in modern history. For the GOP. And Obamacare was relatively modest compared to anything like moving towards single-payer.
5) Obamacare worked, legislatively, by getting buy-in from the healthcare industry. Single-payer cuts out the insurance industry. As ugly as the Obamacare fight was, this would be orders of magnitude uglier. See 4... as in, C4. Kaboom.
Trump is unpopular. If the economy tanks, or something like that, Democrats have a chance at unified government in 2020. Or maybe 2024. Long-term strategy, though... there is something to the notion of trying to move a verboten policy into the realm of the conceivable if you want to implement it.
In practical terms, though, single-payer is a very hard slog, and the idiot trying to lead the campaign is so fucking stupid that he thinks the only reason we don't have it is the campaign finance system. With him leading the legislative push, it is absolutely doomed.
We've seen what happens when stupid people attempt to manage the legislative process of healthcare reform. Whatever you think of Obamacare, single-payer, the pre-Obamacare status quo, or whatever, the notion that Citizens United is the obstacle to single-payer is moronic. That notion is also Bernie's core belief. He campaigned on it. If he is the driving force behind any push for further reforms, they are as doomed as the silly, little games we keep seeing from the GOP on healthcare reform.