Yes, every reason why we don't have universal healthcare comes down to voting in politicians that are against it, but what outsiders and party hardliners fail to appreciate is where the resistance comes. When the Democrats controlled the presidency and both houses, we failed to push out any reasonable form of universal healthcare and that is due to several specific interests that have a hold on the Democrat party then and today.

I would love a Medicare for all, because that's the most cost-effective system we can possibly get short of having no system at all. It'd also increase job mobility--nobody tied to their jobs for "benefits"--and put a sane check the price of basic-level care.

However not all countries with public healthcare are drug-free--Portugal just manages, not solves, its problem despite 50 years of public health--and that's because the incentives to both sell and use these powerful painkillers don't merely go away with a public system. Medical doctors were also complicit; or the more responsible ones, yanked-away the prescription out of caution but unintentionally drove their patients to the black market.

I'll concede that a streamlined system would have helped alert the powers that be sooner, but I'm not convinced that the powers-that-be would have done anything concrete until it became a crisis.