Yeah. Systematically, the USA needs to get a lot of things right. It’s not just Medicare. It’s public health. It’s also issues like time off work/ sick leave as you rightly point out. Of all the countries I’ve worked in, USA had by far the worst time off policies, including for maternity/paternity.
But I think it’s easier to do these things in certain environments. I’m a big advocate of m4a in South Africa where the ANC has not delivered promised socioeconomic gains post independence. The politics and economic structure should make it very easy. Political will is just lacking.
In America though where the healthcare industry is 1/5 of the country’s GDP and capitalism/ individualism are woven into the fabric of the country, building a socialist healthcare system will be much harder to execute. Changing the mindset and disentangling the economic linkages of the existing medical system will require real effort. It’s why I don’t foresee America implementing an m4a system anytime soon.