[smcin]

Sure, but Congress invariably pretend to say the former but mean the latter. You're asking for single-payer instead of privatized health insurance, they will sooner bankrupt the country than switch to sanity. Congress and its funding sources are now captured by privatized health insurance:

In 2023-4, Health came #7 in total political donations, #8 is Lawyers & Lobbyists; the combined "Finance/Insur/RealEst" is #1; would be useful to see "Insurance" broken out by health insurers vs non-health (can anyone cite a more granular breakdown?). [https://www.opensecrets.org/elections-overview/sectors]

[int_19h]

It's not single payer vs privatized insurance. Why is this myth so persistent in US?? There are many different options for public healthcare, of which single payer is but one, and it's not even the most popular worldwide. Many European countries are not single payer, including e.g. Germany.

[smcin]

That would just be just reopening decades of debate in the US.

For whatever reasons, the consensus in the US after decades of talking comes down to single payer vs privatized insurance. Congress isn't going to implement single-payer, so the menu reduces to either we choose good or bad regulation of privatized insurance.

We don't have time for yet another decade of debate, since health insurance premiums (net, post-tax-credit) in the US are about to jump this November open enrollment by median 18% overall, or 114% for people on ACA due to the expiration of enhanced premium tax credits [0]. Expect that to feature prominently in the news cycle by Thanksgiving.

(Germany's multi-payer system (government + mandatory statutory contributory insurance + optional private insurance) would in theory be fine if US Congress was ever incentivized to implement such a thing. But it very clearly isn't, since the 1950s - look at the lobbying money trails. Let the good not be the enemy of the perfect. The ACA was the closest the US (briefly) came to mandatory statutory contributory insurance, but the federal mandate was abolished back in calendar 2019 by the "Tax Cuts and Jobs Act of 2017").

[0]: https://www.kff.org/affordable-care-act/aca-marketplace-prem...

[int_19h]

Have you considered that those decades of debate haven't resulted in a public healthcare system precisely because single payer is what was pushed by the pro side, and many people in US (rightly or wrongly) have a problem with the notion of government telling them that they can't pay money for better healthcare?