This really isn't about "a lot of Americans" - the division between "we want it" and "we don't" isn't that great. It's about politics and money.
Let's work it through more critical, shall we?
Who benefits?
The big health-care systems that can reduce overhead and squeeze pay to people as they get bigger?
The government contractors and insurance companies that will handle/manage the payment systems for a fee (like is done with CMS now)?
The insurance companies that can offload the less profitable patients and sell supplemental insurance?
The politicians that can claim that they "now covered everyone" or "brought the big evil corporations to heel"?
Pharma that depends on FDA/NIH to approve treatments?
Those with the ability to lobby and politicize things?
How about the losers?
The patients, who will be shunted to NPs and get far less doctor time?
The patients who will be handed script after script instead of getting a full and good diagnosis?
Pharma that has seen the likes of Martin Skreli and jacked up med prices?
The local doctor that's already squeezed by reimbursements (Medicare being particularly low)?
What about the docs that won't take medicare now as the reimbursement is too low?
Patients, who will see longer wait times?
Docs and local pharmacies that will be squeezed on price and availability of drugs as production is further crimped?
Folks who might benefit from new technologies?
Rule 1: government doesn't have the capability to handle payments itself. That will be outsourced.
Rule 2: this will not be "universal health care" as in "everyone can see anyone" - it will be government single payer, where a Fed entity will provide payment, but not service.
Rule 3: the deck chairs will be rearranged, but corporations and politicians will still benefit. The little guy won't.
I've worked for/with/in plenty of government agencies myself. There are plenty of ways to "beat the rules", and the rules rarely benefit the little guy. (and to be clear, 'deregulation' of stuff also causes similar disruptions, for example the deregulation of airlines)
This is why I say the entire system needs to be burned to the ground and built up anew. I am realistic enough to know that it's not going to happen.
I'll point to the Covid vaccine right now. A lot of folks are not getting vaccinated (partly a trust issue), and there are doses going to waste. Yet the FDA and NIH are not generally authorizing a third booster shot that manufacturers say are needed (Pfizer being the leading group) and other countries are already being dispensed (noted that they have approved it - only Friday - for a limited group of people). There's evidence that the original shots lose potency over time, and Delta (among others) is much more virulent. The FDA is chartered to provide treatments that are "safe and effective" - the vaccines have proved safe. So in a pandemic, why not lean more to the "safe" side even if the "effective" side is shown to be the case although not as deeply as the "safe side". It's not for money - the Feds have already bought the vaccines (and are sending it to other countries). There must be some other reason for the reluctance. But it's government and politics so we may never know.
You make some good points, but it's worth remembering that there's more than one model for universal healthcare, and they basically all work (with different tradeoffs) better than the ACA. The U.S. wouldn't be forced to follow the Canadian, UK, German, or any other model rigidly; you'd have the option to design one that works best for your country's needs.
Rule 1: government doesn't have the capability to handle payments itself. That will be outsourced.
It's possible, but not inevitable. Canada is huge at outsourcing, probably even more than the U.S. (we even outsource ATC), but the provincial governments still handle billing themselves, because it's not that tricky. It's the healthcare providers, not the patients, who bill, so the numbers — while big — aren't overwhelming, even in a province of 15 million people. I have no reason to think that American governments are less competent/capable than Canadian ones.
Rule 2: this will not be "universal health care" as in "everyone can see anyone" - it will be government single payer, where a Fed entity will provide payment, but not service.
Not all universal healthcare is single-payer. Some systems have the government run health facilities directly (like NHS-run facilities in the UK), while others don't (like Canada); they can both work, and the U.S. would likely prefer a system with private delivery. The main benefit of a standardised system (whether single payer like in Canada, or multiple-payer with fixed rates like in Germany) is that it massively cuts administrative overhead.
As for everyone seeing anyone, neither of our countries have that. In Ontario, some GPs are wide open, while others have long waiting lists. It's up to them to decide if/when to accept new patients. Walk-in clinics and hospitals are open to all, of course. Another restriction in Ontario (which you might not want to copy in the U.S.) is that you mostly aren't allowed to go directly to a specialist; you need to see your family physician first and get a referral (which isn't all that hard, but still, an extra step).
Rule 3: the deck chairs will be rearranged, but corporations and politicians will still benefit. The little guy won't.
Given how much the industry is spending lobbying against universal healthcare in the States right now, they must think the status quo is working pretty well for them from a profit PoV (as do the politicians they finance). Every other rich country in the world switched to universal healthcare decades ago, but the private health insurance industry in the U.S. has been successful at preventing it.
Would some kind of universal healthcare scheme do a better job at reining in the private companies and the politicians in their pockets? It's impossible to know (it would depend on the system and how it's implemented), but it could hardly be worse than it is now, either before or after the introduction of the ACA.
