There were many stories that explained the three tier pricing most hospitals employ — highest cost went to those with private insurance, middling for medicare/medicaid, least expensive for those without insurance. Revamping all this will have a huge ripple, if not tsunami, effect.

I’d suggest to you that eliminating this inefficiency would slice no more than 5% from billings, probably less.

Like any business, the majority cost of delivering service is wages and salaries. Sanders has admitted this, and acknowledged that to make his proposals work, health care professionals would have to take a major haircut in wage — — I concur with estimates that this haircut would be around 40%.

The other major cost area in health care is facility and consumables costs. Those don’t go down just because you changed the insurance scheme.

Most proponents of M4A seem to be operating under the delusion that removing the insurers from the system would save some massive amount of money. Fact is that the insurers operate at about a 2–3% profit margin, and if you get rid of the insurers, the 2–3% you’d save would be immediately offset by the fact that the insurers are *really* good at fraud control, while the government is relatively clueless on how to prevent fraud.

Then, there is the larger cost problem of setting up a single payer system for the first time (Medicare is not a single payer system).

The unfortunate part of any kind of change on this scale, whether health care, coverage, tax reform, etc, unless someone can roll it out in deliberate and deliberated waves, there is going to be disruption, both detrimental and beneficial.

Precisely.