Here's what happened today: the medical device and pharmaceutical and insurance companies all got together to release a letter claiming they're committed to lowering health care costs. That is basically what needs to happen for there to be anything resembling universal coverage, because right now we all pay way, way more than everyone else in the world for care that is not discernibly better, and if you're poor, you're paying even more for even worse care, because that is the American way.
But here is the problem: none of the people from those companies actually mean it. When you say "reducing health care costs" what you are actually saying is "reducing the insane profits of medical device and pharmaceutical and insurance companies." So they were standing with Obama claiming to be with him all the way because they know something's going to happen, but once it begins actually happening they will fight tooth and nail to make sure it's piecemeal and ineffective.
Here is the bad news: because of those insane costs, a public plan will look incredibly expensive when the Congressional Budget Office does the numbers. And nothing will get passed in Congress unless it pays for itself—the ballooning deficit increases, while basically inevitable, are going to make it really, really hard for some members of Congress to get on board with anything that involves spending any money for the next four years. But, you know, this is the kind of shit, short of NOT SPENDING TEN ZILLION DOLLARS ON DEFENSE EVERY YEAR, that would drastically cut the huge "Medicare" bit of the deficit.
So... honestly? We have no clue. We keep getting super-excited for a great big public insurance plan, and then we are like "oh wait our Socialist dreams never, ever come true." Bernie Sanders introduces the single-payer bill every year and it just sits there. But, you know, new era! They are holding so many important serious round tables, in congress! Round tables always lead to action!
To sum up, we will continue smoking, drinking, and being uninsured, with the vague hope that eventually the government will take care of us, eventually.