re: Why does the healthcare debate essentially revolve around like 4% of Americans?

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run by public health specialists and physicians and their health outcomes are excellent.

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We're going the opposite direction here. The ACA removed much of insurer's ability to assess and tie reimbursement to medical appropriateness. The ACA did a lot to discourage physician owned facilities. And some of the proposals since.. are even more draconian.

I see nothing into indicate creation of a single payer system would decrease this trend. In fact, I can see it worsening it.

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You're a smart guy - go back and read that Gawande article. It demonstrates nicely how much worthless care exists and how physician hubris feeds into it.

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Again you've setup the false choice. Single-payer is not the only... nor even the best way to reduce this. Patients paying out-of-pocket are far more unlikely to pay for unnecessary care then subsidized PTs. Government... well... look at defense contracting and tell me they are good at making good purchasing choices. And I'd reckon that defense needs assessments are far clearer, more objective, and far less individualized than medical needs assessments.

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does a lot more than that since it radically reduces Federal spending that will almost surely not be picked up in a lot of states

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In the short term... sure. But when people lose their freebies, they'll be back demanding more. They are still demanding more at today's level of spending. Cutting won't cure the collective greed.