politics

That's what I'm saying. If we only have a majority that depends on Manchin and Sinema, how are we supposed to pass the public option? How do you get a majority without them?

And the reality is that passing the public option isn't simple. Look at the institutional holders of three of the top insurance companies (United Health, Cigna, and Humana):

https://money.cnn.com/quote/shareholders/shareholders.html?symb=UNH&subView=institutional

https://money.cnn.com/quote/shareholders/shareholders.html?symb=CI&subView=institutional

https://money.cnn.com/quote/shareholders/shareholders.html?symb=HUM&subView=institutional

All those mutual funds hold a lot of people's pensions/retirement. So if you pass medicare for all, what do you do with those investors. It's not just rich fat cats, but also folks looking to retire.

I wish we'd have a real discussion beyond medicare is more comprehensive, cheaper (I don't think a lot of people realize that you still owe 20% of part A bills and have to pay a premium every month for part B, and still have to deal with paying for drugs as part of Part D, and that medicare gap is only available through private companies (forget medicare advantage), and patient friendly. We have to figure out how to handle the consequences of essentially nationalizing an entire industry.

And it's not just the insurance companies their investors that you have to battle here. You have to deal with big pharma who are doing everything possible to block medicare from using their market power to negotiate lower drug costs. And this whole private system leads to such ridiculous allocation of spending. You usually see big Pharma spending more money on SGA (https://www.fiercepharma.com/special-reports/top-10-pharma-drug-brand-ad-spenders-2022) than R&D. Yet they'll argue that getting drugs through the three stages of clinical trials is really expensive and justifies the prices they place on these drugs.

Of course if you get rid of that inefficiency, it's a whole bunch of advertisers and executives out of the job, and they ostensibly spend less money in the economy or find jobs in a different field. It's all a giant, interconnected web, and we're just trying to redistribute the composition of it.

I often point to the Kaiser Permanente poll on the popularity of Medicare for all. Sure people are for it. But then when you tell them that their private insurance would go away, favoribility drops to 30%. Can you imagine if you told them their pension funds or retirement is invested in health insurance companies or big pharma? See figure 9: https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/

And I agree with you about feeling the coalition's one sided. But I think Biden is trying with his executive and judicial appointments which only have to go through the Senate. And you really have to walk that fine line between negotiating a better deal/agenda reflective of your needs/wants and not being taken for granted (something the progressive caucus in the House did a terrible job at in negotiating with Manchin) and letting the right extreme coalition run everything. And one of the ways to do that is to run your candidate in the primary (we focus too much on the presidential, when we should be looking at more local representatives too), working for them or volunteering for them, and engage in dialogue that reaches their ears about your demands if they want you to be part of that coalition.