American universal healthcare would mean eliminating a huge pile of profits for healthcare-related companirs that are effectively just charging you rent for the privilege of going to a doctor. Those companies are large donors and fund think tanks that spread PR about how it is actually fiscally irresponsible to pay less for healthcare while changing where the balance sheet is calculated and what will happen to all of those jobs predicated on wasting your time and money to get healthcare?

You will not get universal healthcare, let alone single payer healthcare, without having some kind of leverage and using it in a disciplined way. And unless you are a CEO, your leverage can only come from collective organizing, of power in numbers, of political education so that everyone in the org is practically aligned on these goals and will noy disintegrate or be coopted by liberals.

The last ~45 years of grinding neoliberalism shows me little reason to believe that we can.

The US has never been and will never be a democracy, because it was born of a bourgeois revolution[1]. The wealthy, white, male, land-owning, largely slave-owning Founding Fathers constructed a bourgeois state with “checks and balances” against the “tyranny of the majority”. It was never meant to represent the majority—the working class—and it never has, despite eventually allowing women and non-whites (at least those not disenfranchised by the carceral system) to vote. [Princeton & Northwestern] Study: US is an oligarchy, not a democracy

The US working class got some temporary gains in the 20th century (and I could describe the extraordinary—unique, really—causes of them), but those are very unlikely to ever fully return under capitalism.