Why would it happen now, when it has failed to happen for the last hundred years? Also what about this country makes you think that the social safety net is getting any stronger?
In my lifetime we have eliminated cash welfare, we have effectively ended private sector unions, most states have switched to at will employment, we privatized a good chunk of K-12 education through the charter school system, we have shut down almost every mental health facility in the country, we mostly stopped subsidizing college education, we watched the effective minimum wage get cut in half by inflation, and we have brought back non-dischargeable non-criminal debt for the first time since the American revolution. Right now the only additional changes that Congress is proposing are cuts to Medicaid and food stamps. We're closer to Victorian England than universal healthcare and the trajectory doesn't seem to be changing.
This is all true, but eventually we're going to run into the cold, hard wall of demographic transformation and a permanent democrat/socialist majority. Mass immigration has ensured it. The demographics are already baked in to flip Texas blue, the only question now is exactly when it will happen. Same thing with Arizona, it's just a matter of time, and while I haven't seen any population structure analyses of these two states my guess is that it will happen within 10 years for both.
Once the 'rats are secure in their one party state, you will see a rapid reversal of the changes you noted above. The prevailing strategy of the top and the bottom against the middle will be ratcheted up to new extremes. What is left of the middle class will be squeezed dry to pay off the ever expanding underclass and thus allow the elites to continue feeding at the trough.
Still, this will take time. We certainly won't get single payer during the next 4 years of the Trump administration. After that, the chances that the Republicans lose the White House
and get decimated in the House and Senate by a big enough margin to allow the 'rats to push through single payer immediately are small. Realistically, we're looking at 8 years at the minimum until the 'rats can pass single payer, worse case scenario.
So in 2024 single payer is passed. It will probably take them at least a decade from the time the bill is signed to actually transition from private insurance to single payer. Obamacare was signed in 2010 and still hasn't finished the implementation process, and with single payer we're talking about a far more dramatic transformation, one that can reasonably be expected to take even more time.
Let's say by 2030 single payer is firmly in place. They won't want to gut physician salaries right off the bat, because that would potentially create massive disruption in healthcare delivery as the better off physicians retire early, what's left of private practice closes down, and massive discontent within physician ranks manifests itself as, eh...substandard patient experiences. They will prefer to take the boiling frog approach to destroying the American healthcare system and slowly acclimatize people's expectations rather than suffer the political repercussions of taking the "flipping a switch" approach.
With all that said, I'd estimate 2035 is the earliest possible arrival date of the worst case 'socialized medicine, 50% paycut' scenario. I'll be finished with training by 2023 or 2024, so I'll have around a decade to work the most undesirable holiday and weekend shifts, in the worst and most hard to staff locations I can find, and stash cash. If I can make an average of 500k for 10 years I'll be home free and be sipping mojitos from the deck of my catamaran by age 40, watching the clusterfck of socialized America from a safe distance.