None of these things will happen until the power of the professional classes is broken. They will fight it, and you will find that you don't have the votes in congress to do any of this stuff. Seriously people are walking into an oncoming freight train thinking they will reorganize 20% of the economy through the power of sheer idealism and it would be funny if the stakes weren't real. But we will meet again in 20 years when the situation is much worse, and you will be confused as all hell why none of these plans were realized. As long as the professionals are in the drivers seat of the Democratic party, you can push the truck as hard as you want but they will steer it towards an Obamacare style solution, at which point you will say "We must push harder! It will happen!"

But it will never happen, not as long as the Neera Tandens of this world are calling the shots in the Democratic Party.

This is all accurate.

And the Medicare For All movement knows it.

Organizing to take seats, build something like a 10 million volunteer group, and plans for all that to be very highly active, are in the works.

The current system is completely unacceptable. As it has come into it's own now, the number of impacted Americans will grow rapidly.

I expect there will be significant unrest over this issue.

Yes, there has to be unrest. Promising all sorts of benefits isn't the battle. Those who think they can combine the exorbitant spending of a US system with the social financing of a European system are not serious players in these discussions.

Same for universities. If you want European style public financing of Universities, get ready for a system where universities accept only 1/2 of the students that American universities accept, where a degree lasts only 3 years, and where total spending per student is 50% of the US level even on a GDP basis.

This is the kind of the system that you can get the public to agree to fully fund, and it again requires massive cuts to university staffing, shutting down a lot of schools, as well as lower salaries (on average) of those who remain.

When that starts polling well together with the free tuition part, then you know you have real backing for a European style system.

I'm from Europe and I think European systems are more rational and ultimately much more humane, but they are so far different from what is happening in the U.S. that when I see the college kids argue "why can't we have what they have in Germany/France", I want to yell back "If we had a French system you would have never been accepted to University." People have no idea of whether or not these moves will be popular.

Keep in mind that when European nations adopted universal health systems, the health care sector was a small part of the economy and the nations were politically united with high levels of social trust and solidarity.

When England adopted the National Health Service act in 1946, healthcare was less than 3% of GDP (https://www.nuffieldtrust.org.uk/chart/nhs-spending-as-a-per...) and the nation had high levels of social trust especially trust in government (they just won WW2, large portions of the economy were nationalized, they were used to rationing, etc). Even then it took a big battle, with lots of organizing to get it done.

So when people say "why can't we do what the Europeans did", the Europeans never took over 20% of their economy, they took over ~3% of their economy and that grew to 10%

There is a big difference in the political battle to take 3% versus 20%. Today, in almost every city the hospital is the biggest employer. Healthcare workers are huge political players, and while they certainly favor more government spending, they do not favor more cuts. But taxpayers favor the free stuff, not the "we will tax you more" part. These are huge requirements for social trust and especially trust in government. But now, the U.S. is as divided as never before and social trust, particularly trust in government, is rapidly falling. (source: https://www.pewresearch.org/fact-tank/2019/07/22/key-finding...). The younger generation is in the curious position of demanding more free stuff while also trusting government the least of any generation.

So when all these people say "Hey, free stuff polls really well, we can do this people", I just roll my eyes. This would be 10x the achievement of what the Europeans accomplished and in a nation completely divided and growing farther apart each day.

"free stuff" is a pretty flippant way to describe a social service covered by taxes.

It's not at all flippant when one side describes the benefits but not the costs. If it was marketed accurately, I wouldn't call it the free stuff platform. But then if it was marketed accurately you wouldn't have the majority of people thinking that medicare for all was really a public option proposal, or Kamala Harris throwing smoke in people's eyes by simultaneously distancing herself from medicare for all while also advocating for it. Let's be honest about the level of honesty here.

Question: Why the focus only at the national level? Why can't a state execute this plan if the costs are reasonable?

Correct. The only reason a state can't execute the plan is that the bulk of the heavy lifting has to be done on the cost control side which is interstate commerce. Hell, an individual city or even neighborhood could create an insurance pool if it was affordable. Healthcare is not a financing problem or an insurance/risk pooling problem, it's almost entirely a cost control problem.