For the first time in years, countless Americans are going through their daily lives with a pervasive sense of dread. That it comes amid new evidence that the nation’s super-high priced health care system is inadequate for dealing with a pandemic only increases the worry.

Even before the coronavirus, the beachhead established by the Affordable Care Act was receding, not primarily through the Republican assault on it in Congress and the courts, but the inevitable erosion produced by a system that rewards waste and punishes thrift.

The ACA tried to square the circle by expanding access to both public and private systems. The former, through Medicaid expansion, worked pretty well, as least where governors cooperated.

The private expansion, however, has failed. Tens of millions of Americans have discovered that their previous employer-paid health insurance is now paid, in increasing amounts, by themselves.

Consumer payments, through premiums and especially through co-pays and deductibles, are the fastest growing part of the payment pie, and employers increasingly provide inadequate lump sums, while instructing employees to buy their own insurance.

And that doesn’t include the tens of millions who’ve lost their jobs. For them, dread of “The Bill,” surprise or not, has become overwhelming.

Yet polls indicate there’s still one aspect of Medicare for All, the most promising reform initiative since Medicare itself, in 1965, that hasn’t quite registered. Despite the evidence that the private insurance system, declining since the 1980s, has now failed, many fear losing it.

The obvious answer: that you’re not losing your private insurance, you’re gaining much more reliable and affordable public insurance, hasn’t yet become real.

So we need this time not only to shore up support for the switch to a public system – the only way to overcome the perverse financial incentives of American health care – but to reform Medicare itself, which needs it.

It’s heartening that at least one Maine candidate, Betsy Sweet, running for U.S. Sen. Susan Collins’s seat, is rising to the challenge. Sweet, unlike many Medicare-for-All enthusiasts, recognizes that Medicare, despite its universal coverage for those over 65, has systemic problems, too.

Most were introduced by the “reform” package backed by Republican President George W. Bush, and enacted in 2003 with too-credulous support from Democrats. For the first time, Medicare fully covered most prescription drug costs, but it did so in an unfortunate manner.

The program was never adequately funded, and immediately went further into the red through an irresponsible clause, at GOP insistence, that Medicare couldn’t “negotiate” with drug companies, but must pay whatever they asked.

Another regrettable provision was the inclusion of private insurance within Medicare, the so-called “Advantage plans.” These supplements do provide valuable benefits, but they’re largely funded by the taxpayers, and insurance companies make still more profit.

Sweet is calling for true reform by using the government’s formidable buying power to drive down prescription prices, and to remove the private offerings and replace them with public alternatives with the same benefits.

There was never any reason for privatized Medicare. From the beginning, the insurance companies have been the benefit managers – one reason why Medicare’s stated administrative costs are so low – and do a reasonably good job, though that role, too, should get more scrutiny.

Privatization was the Republicans’ major goal, amply rewarded by a steady flow of campaign contributions, and abetted by Democrats who simply wanted to expand Medicare benefits without understanding they were undermining its future as a public program.

If all this seems a bit complicated, it isn’t, really. All the other advanced nations on this globe have public insurance systems, or private ones so tightly regulated they could never function here.

Returning Medicare to its public purposes is a necessary first step to gradually expanding eligibility to more Americans – lowering the age of enrollment to 60, and then 55. Yes, it would seem expensive, but far less expensive than sticking with the current failed methods.

And the savings – yes, savings – could be reinvested so the gap between Medicare and Medicaid, ineligibility and income levels, could eventually disappear, with Medicare for All finally achieved.

Some activists will be disappointed that universal coverage through public programs can’t be achieved sooner, but the problem of soaring costs and failing access took 50 years to develop, and it’s not going to be solved overnight.

The good news is that it is achievable, and can overcome any lingering doubts voters might still have. And the best way to start is by electing the right candidates to Congress.

Douglas Rooks, a Maine editor, reporter, opinion writer and author for 35 years, has published books about George Mitchell, and the Maine Democratic Party. He welcomes comment at drooks@tds.net