[theptip]

I understand the pessimism -- and I think you're right that lobbying and economic inertia are the reasons that change has taken so long.

However I think there is cause for reserved optimism; the ACA moved the Overton Window on this subject. Sanders and Warren made Medicare For All a core part of their platform, and did not get killed for it. Biden supports a public option (Medicare buy-in, not single payer), but that is now the moderate / bipartisan position in terms of voter support.

We will probably not get a single payer solution in this administration, but the public option could capture some of the market, and make further changes more tractable.