Hey Ryan! Good to hear from you.

I think you're spot on that this is something that needs buy-in from the bureaucracy. I think a lot of people in the bureaucracy are frustrated by the system as is, though -- especially since the implementation of Obamacare and the shift of more Medicaid and Medicare services to private insurers, I'm sure they're fielding calls from people that they can't help because of Aetna or whoever is fucking them over.

Where I disagree is that I think that, like with gun control or any other issue, the political willpower is way behind public support. Most polls show that Medicare for All has majority approval among all voters and I think that number would be growing exponentially right now if the Democratic nominee was pitching it even as a temporary solution to get these 5.4 million (likely more than that) back on healthcare coverage. It's not overwhelming support, of course, but over the past five years it's gone from a fringe position to something that most Democrats and independents are interested in moving towards.

The bigger problem is that there is nothing more insular than a congressional Democrat, and in many cases, it's not just a matter of ideological disagreement but one where they're breaking with an entire industry that's very active in the political process. Republicans are a lost cause, but if you have Obama 2009-2010-style majorities and broad consensus within the party on Medicare for All, it becomes a reality overnight.

I think it's a three-pronged process: getting support for it from someone like Biden, a mainstream centrist who's a party leader, convincing swing seat Democrats that it won't kill their re-election chances (or that it's worth killing their re-election chances for), and most importantly, successfully replacing safe seat Democrats who oppose it (or support it only nominally) with people who will actively fight for it. More AOCs and Jamaal Bowmans, basically.

At this point, with Bernie out of the race, I think it's a 10-20 year project, and maybe something to be rolled into the Green New Deal. But I think the more healthcare and economic crises we go through, the more people get moved away from traditional jobs towards gig work, and so on, the more people are going to wake up to the reality that employer-based health insurance is only fundamentally not fair, but not feasible either.

Hope all of that fleshes out my view on what it'd take to get to Medicare for All a bit more. Thanks for subscribing!