Why?
Because it would knock out most of our cars, electronics, payment systems, farm machinery, and everything else that we depend on to keep the supply chains our grocery stores depend on for food distribution.
See https://nationalinterest.org/blog/buzz/millions-americans-co... for verification.
I have no idea where your "worst case scenarios" come from. But they don't exactly seem "worst case" to me!
Nationwide long term total blackout is unlikely for many reasons.
(and it should be further noted that this conclusion was that the US carrying capacity for life would decrease to 30m sustained by like subsistence agriculture. I expect that those deaths of hundreds of millions would be over decades, not quickly, and I really really doubt that we'd be unable to recover more than some of our agricultural capacity in a decade)
See https://chris-said.io/2020/06/18/everything-ive-learned-abou...
Regardless of which side you believe, it is clear that any "worst case scenario" should include the possibility of an EMP attack that actually does take out the power grid.
Things are setup to fail safe which preserves equipment but defaults to turning everything off. Getting significant parts of the grid up again should take days even if your stuck with rolling blackouts for years.
Further, EMP isn’t a magic wand that instantly destroys all electronics, there is a huge range of sensitivity not just based on type of equipment but also if it’s running and the orientation it’s in. Taking out farm equipment that’s off is really difficult. The actual nukes are a much larger threat.
Even people in areas with no nukes, little fallout and not affected by nuclear winter could face mass starvation due to lack of fertilizers, diesel, spare parts for machines, etc.
Even in North America, Europe and North Asia, having the electric grids knocked out, central administrations crippled, much industry and agricultural infrastructure knocked out, followed by nuclear winter might see more people die from cold and starvation than from the nukes themselves.
Anyway, I don't think we really want to test this, even if the total numbers do not fully add up to complete destruction.
Recent figures I read were 20M-40M for worst case scenarios.
Realistically, a coordinated all in launch is ~1000 warheads, with 400 of them megaton scale in R36 MIRVs from West Siberia.
First strike is only possible with computerised launch infrastructure operational. Beheading the command structure is a way to prevent an effective first strike.
Without it, assorted launches get detected early, giving time for counterattack.
The missile defence can much more easily shoot down 20 boosting missiles coming one by one, than 10 missiles coming simultaneously.