I was really, really young back in the Ma Bell days. I just remember that the phones were extremely hard to break.

I think a more accessible analogy might be something like Microsoft. I use the wares of Gates, usually, even though I bitch about it all the time. I could use a Mac if I wanted to, and I've played around with open source stuff enough to think, "I could probably make this work."

There's no absolutely perfect solution, but the ones that are out there offer enough flex that anyone can compute. Access to healthcare could be much improved by some judicious regulation that favors consumers, which my probably-too-simple suggestions attempt.

But back to Ma Bell. When I think of Medicare scaled to single payer, that's exactly the kind of monolithic (potential) goatf*ck that comes to mind; part of the reason Medicare works is that it is a piece of a puzzle instead of being the whole thing. What is it about the fact that the government would be running it that makes it seem so much more attractive/effective than if it were being operated by private parties?

Legislation NEVER gives anyone or anything a soul or a heart. It just, hopefully, prevents them from behaving badly and/or punishes them when they do.

...you and all the other opponents of a public option are relying on the good-heartedness of the insurance industry to do right by their customers.

Trust health insurance CEOs? Hardly. I'm saying remove some of their more abhorrent options.

Regulation right now favors the interests of the insurance industry. I identify that as very problematic and suggest changing the regulatory environment to as to favor people who need access to healthcare.

You seem to believe that government somehow has more of a soul than do private corporations, and you might believe that a single payer system run by the government will be a real evolution in healthcare access. You're entitled to believe such things, but I don't see any evidence to suggest that you're right. I still remain to be convinced that single payer won't be a step towards a more uniform level of mediocrity at best.

Medicare has more than 44 million enrollees and represents 22% of health care spending in the U.S. My guess is that it's the largest insurance program in the world. So yes, it scales.

One problem with Medicare is that the costs are higher per capita than the general population. This is due to the fact that Medicare enrollees are seniors and people with disabilities, who typically have more health problems. If it were spread out to cover everyone it would be more efficient.

My personal experience of observing the care received by Medicare patients is that it is as good or better than private insurance.