If ACA mandates are upheld, we won't get Medicare-for-All and better health care for a generation.

[jeff47]

38. Because the mandate isn't the only part of the ACA.

The other key feature is the "Cadillac Health Plan Tax". It's extremely poorly indexed. So more and more companies are going to bump into it. That removes the incentives for companies to provide health insurance. Which tosses more people into the exchanges.

"Ah-ha", you say, "they're still at the mercy of private insurance". And yes, they will be at first. But I think we can count on health insurance companies to be greedy enough to screw people over. In response, blue-ish states will add a public option to their exchanges. Without the need for profit, it should turn out to be the cheapest plan. So people will buy it. Others will see the public option folks aren't falling over dead and receive similar care for less money. So more people buy it, improving the option's cost-sharing. Which makes it even cheaper and help more states add one to their exchanges.

The success in the blue and purple states will deprive the insurance companies of lots of money, reducing their political influence. At the same time, more people won't be dropping dead. That will make even the red states eventually offer their own public option.

Results in de-facto single payer through a Rube Goldberg system. And it will take a while. But it will happen much, much faster than single-payer can pass Congress.