The reasons why the single payer movement is so reluctant to compromise (per an analysis posted recently on the web):
1. History - The single payer movement has been working for a system where all healthcare is funded through one fund for at least 15 years. The now 3 bills that exist in congress which would bring about such a system is a distinctly "American" form of "single payer" in its elimination of privatized health insurance altogether.
Suggesting that those who have been working for over 15 years towards such a system simply compromise is naive. I don't know how long you've been at this or how old you are but some in this movement are now in their 70s and 80s and, as you might imagine, have been witness to more losses than wins regarding many progressive issues - most natably, the war in Iraq.
2. Sustainability - We also see in the hybrid systems in your examples problems creeping in that we see on a daily and massive levels: rising costs, reduced access, and other problems that are attributable to the addition of private care options. But more importantly, the hybrid system has now been tested in 5 states (with Mass. being the state that is most publicized) and the result shows clearly that it is not a sustainable model. The pool supported by the public is filled with primarily the sickest and poorest - those who, with premiums from the private plans rising, have had to bail on their private plan.
3. Political Viability - Many in the single payer movement (including those elders I mentioned) recall for so many years the reasoning against the passage of 676, 703, and now 898 being a majority Democrat, etc. that would be required to pass any bill and we were far from having that. Now, not only do we have that in place but we also have the power, we have learned recently, of using the "reconciliation" tool. Per my note about Iraq and the "compromise" some of these same folks made 2 years ago re the continued funding of the war in Iraq, the sentiment is, in Obama's own words, "enough is enough".
4. Timing - Many if not most in the movement see this time as THEE moment. We have an opportunity to bring this change about and not just apply a bandaid (which we can see will wear off after a while). We have a chance to do it right this time and we've even supplied a road map to getting there (i.e., expanding Medicare to all). The fact is, the United States constitution came about as a result of the failure of the Articles of Confederation. We ripped up that constitution v.1.0 altogether after valiant efforts of trying over and over again to fix and patch it and we just created an all new one ...the one and only that we live and function by today.
Given the possiblity of expanding Medicare vs. dismantling some big implied healthcare system, the preferred by you and me and so many on the left system - single payer publicly funded universal healthcare - we see as pretty easy compared with the task we faced as a nation in 1787 ...and equally vital.
Just remember that whatever is enacted should be a national system. The state systems would fail for many reasons, but most of all because few state budgets put them in anything resembling a start up position, unless the law funds the startup of state systems by Federal funding (remember, states can't print their own money!!).
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