In defense of small changes, the 2nd term Trump administration is a great example for why it should be difficult to make big changes. Even with the decent guardrail, he is able to completely destroy congressional mandated agencies, implement random tariffs (tariffs are back BTW), use DoJ as personal revenge agency. There should be a small appreciation of what we have today when compared to the last three thousand years of history. Things really can get a lot worse and very quickly.
Do I want Medicaid for all/single payer, yes.
Would I settle for Medicaid for those who want it, definitely.
I think that is a point worth considering too. I would argue we have incrementally been in decline regarding workers for 4 decades, and just not doing that would have also avoided Trump. Anyway we probably mostly agree.