However there is a trust issue here, how can Americans truly trust their government to implement it right when the same government cannot get the VA right and worse there seems to be active opposition within the VA and government to right it?

Throw in the BIS run systems which make the VA look good and its a very hard sale.

A lot of the cost of medical care is because there are too many limits on competition for both services and insurance. It certainly needs reform but to get the trust of the people it must prove it can run what it has