Single-payer proposals have failed in state referenda in non-conservative states.

Yeah, the median voter position is not all the way to single payer but is still left of the status quo

Is it? Where do you see the boundaries here?

Polls consistently show the public supports Democrats more than Republicans on healthcare policy, even as they trust Republicans more on other issues like inflation and immigration

https://www.the-independent.com/news/world/americas/us-polit...

Right, I'm a pretty engaged Democrat, but I'm asking: what reforms do you think are within the boundaries of acceptable to the median voter? Clearly single-payer is not. It couldn't even survive in Vermont.

as someone from VT, VT was way too small to do single-payer on it's own The whole point of single payer is to have a monopsony that can effectively negotiate with everyone else. For it to have a chance, they would have had to join with MA.

I think the reform that would be acceptable to the median voter is a public option for Obamacare. Just let people select Medicare as an option instead of one of the private companies (and even better, let companies provide it as an option for their employees as well).

thats the option that I have always preferred, provided the opt in Medicare/medicaid option is provided at cost to the general public.

If set up this way, I dont see why anyone would reject it. At worst, it would be another option amongst many.

The poison pill would be if opt-in medicare was funded from taxes on the general public who were paying concurrently for their private insurance. Medicaid funding would continue to support the poor.

However, this would only be a start. The real problem with US healthcare is a lack of spending controls. European socialized healthcare refuses to purchase treatment if the cost/Quality of life improvement is too low.

There are two broad concerns with public-option M4A:

* The resulting customer shifts will result in private insurance becoming more expensive or, worse, exiting some markets, which violates the requirement people have that, in the worst case, their current insurance remain accessible to them.

* The resulting customer shifts will drastically increase the cost of Medicare, threatening the existing program with benefit cuts.

I agree that those are the public concerns. regarding the second bullet, this is why I suggest a separate pool offered at cost.

Regarding the first, I dont think that this is a forgone conclusion, at least immediately, but admit I haven't thought through how the transition would work. With any public option gaining members, there are bound to be insures that lose them.

The majority of Americans believe the Federal government should provide health care [1][2].

The current Democratic Party is essentially "Republican Lite", Republican with a happy face on it. Democrats as a whole are more interested in defeating progressives and leftists than they are in defeating Republicans.

[1]: https://news.gallup.com/poll/468401/majority-say-gov-ensure-...

[2]: https://thehill.com/policy/healthcare/351928-poll-majority-s...

This is issue polling. There are lots of problems with issue polling, but even when delivered well, the fundamental problem is it's not concrete. Poll people to see if they'd like the option to stop paying for health insurance: you'll get Assad numbers. Now write a ballot initiative for single payer, where customers see the tax price tag, and have to worry about losing their current private health insurance: the numbers fall through the floor. This isn't supposition: it's happened over and over for the past several election cycles. People do not like this idea as a concrete thing.

I'm a Coloradan who voted for the 2016 universal healthcare (aka ColoradoCare) proposal, but I understand why the majority (79%) voted against it: there was sticker shock at the additional 10% income tax (with caveats, but people saw the 10%) and an inability of proponents to answer basic questions such as "Will I be able to keep my current doctor?", "Will I be able to get an abortion?", and "Will there be additional tax increases?".

I remember polling either done at the same time or the same pollster that found different approval ratings for Obamacare and the ACA. Its like dihydrogen monoxide vs water.

Right, but the point is (I'm belaboring) we don't have to rely on issue polling at all here, because has repeatedly made it to actual ballots, which are the votes that actually count.

The public is very dissatisfied with the current situation. However, they reject any solution put forward.

Approval is high for "Something Else" but low for the alternatives.