Americans aren’t stupid; they know their health care system is terrible. They are, however, generally risk-averse; they’re afraid (not without reason) that any attempt to completely remake the system by the government will actually leave them worse off. Add the hundreds of billions of dollars in vested interests on the part of providers and insurance companies to the equation, and you have a recipe for stasis. That’s where we are right now.
So how would you go about building a consensus for meaningful change? You would start by assuming that only incremental reforms are realistically possible. You would then move on to the low-lying fruit, such as controlling drug prices. You could take some of the proceeds from tax increases on the wealthy and use them to cut copayments within the framework of the existing system. Finally, you could at least consider adding a public option; that’s about as far as the envelope could be pushed, and even that might not be possible.