I think the "political reality" attitude is an interesting one, but can be used as an excuse. I'm not convinced that it isn't possible to scale up to the entir

I think the "political reality" attitude is an interesting one, but can be used as an excuse. I'm not convinced that it isn't possible to scale up to the entire US population in a way that doesn't suck, but you could be right. To work well it would certainly involve systemic change across the healthcare industry, and some current players would be hurt. Perhaps it's not politically feasible in the US, but if so that is a pretty damning indictment of the state of things.