Ex Ante Public Opinion Is Not Why It’s Nearly Impossible to Pass Single Payer In the U.S.

Since I’ve seen this poll touted in multiple places as evidence that of course single payer is viable except that the Democrat Party Won’t. Even. Try., I guess I need to belabor the obvious:

• If you think any non-trivial number of Republicans — let alone 40%! — would support Medicare-For-All NATIONALIZING ONE SEVENTH OF THE ECONOMY AND RATIONING AND STARVING GRANDMA TO DEATH once it was actually proposed by an actual Democratic president, let’s set up a poker game ASAP.
• In March 2009, 72% of the public favored the Affordable Care Act. Remember what a snap passing that was? Remember how well that popularity held up? It’s easy to get people to agree in the abstract to replacing the existing health care system with something better, but once the actual tradeoffs are on the table (often distorted by the bill’s opponents), it’s a different story.
• All plans for further comprehensive reform have to deal honestly with the paradox that while people are often unhappy with the system in general they tend to be happy with their coverage in particular. (Note that while 72% of Democrats favor single payer, 79% want to keep the ACA as is.) The fact that people who have Medicare have no incentive for further comprehensive reform is a particular problem.
• And, of course, maintaining public opinion is the least of the problems single payer faces. The fact that virtually every powerful vested interest — not just insurance interests but medical practitioners, big pharma, hospitals, etc. etc. — would be in five-alarm opposition makes it virtually impossible to pass single-payer even if the public was really strongly behind it ex ante.
• If the United States ever gets a European-style health care system, which should absolutely be a liberal goal, it is massively more likely to be a hybrid model that builds on the ACA than a single-payer or nationalized system. Given that single-payer does not inherently produce better results than hybrid systems, this isn’t necessarily a major problem.