And the medical / insurance industries will ramp up a lobbying and advertising effort like we’ve never seen. The term “Medicare for All” was a good try at reframing what would otherwise have been called “socialized medicine,” but the frame appeals primarily to the progressive spirit of nurturing all, of healthcare as a universal right. Most people aren’t there yet, not to mention a conservatively emboldened judiciary poised to strike down or delay attempts at major reform.

Single payer is the most rational insurance system, but people aren’t inherently rational and the educational process to get them past their initial resistance (which will be reinforced by industry opposition) could take years.

Even then, a rational healthcare insurance system will have limited impact without a rational healthcare system. (We don’t have even a rational prescription drug policy .)

I’m glad Sanders, Warren, and others have started the effort, but it’s likely to be a very long and bumpy ride. Ideally essays like yours will keep us committed to the goal.