You aren't wrong that premiums are a healthcare tax, of which a too high percentage goes to the insurance conglomerates. But you left out a lot of important information 1. Who would run M4A, and how would that person(s) be selected and how often? Right now the Sec of HHS has discretion over everything, and we appoint a new one every 4 to 8 years, or more.. The implications are obvious. 2. What is not covered ? Is every $4m therapy going to be covered ? Even when you negotiate, it won't be cheap. What about the most expensive life saving equipment? It's not like the feds are good at negotiating healthcare 3. Who gets paid less ? Doctors ? Nurses? Specialists? 4. You assume employers will pass along what they don't pay for their share of benefits, to the employee. Do you live in the USA ? This assumption is unfortunately laughable and nothing in an M4A bill can change that 5. Much of medicare/medicaid is run by outside companies. Many of whom are the very worst actors in the healthcare industry. How do you replace them all ? How many years do you think that will take ? or Do you expect them all to become good actors and do the right thing rather than try to maximize earnings? 6. Hospitals don't know what their procedures cost them to perform. They use derivative cost accounting like cost to charge ratios, or, only show Medicare Cost Reports, and basically just look at how much cash they have on their books. Which is one of the reasons they are able to say they don't make money from Care/Caid patients. I don't think many understand what the concept of margin contribution is. If they don't know what their costs are, and you don't know what the actual costs are, how are you going to be able to work from a budget to determine total costs ? That said, Im for Universal Coverage. But till you know what it actually costs to deliver care in this country, its going to be near impossible to make work How do other countries do it ? Most started on this 30 years or more ago. Pre MRI machines. Pre Cell and Gene Therapies. They were able to start at a time when healthcare was much simpler, and evolve, some successfully, some less so, from that point. This is my opinion. If you disagree with any of it, happy to read it here