Imagine Single-Payer Healthcare and what the reaction would be.

[JoePhilly]

16. That's why I think the path to single payer goes through a public option path.

We can't jump all the way to the end.

1) The ACA sets up state and federal exchanges. Not perfect, but much better than what we had.
2) Blue states add public options to their exchanges. This makes things even better in those states.
3) The Federal exchanges (after some screaming from the right) adds a public option, perhaps as a buy-in to Medicare.
4) Insurers struggle to compete in the blue states.
5) Insurers struggle to compete in the red states.
6) State plans and Federal plan compete with each other ... they improve as a result.
7) We reach a point where insurance companies give up.

I won't be surprised if we end up with a Federal plan and then an array of state plans.

But I don't see the US jumping directly to that final step. Its going to be a process.