One of the issues often pointed out about single-payer, Medicare-for-all is that the US system has an extreme problem with prices and processes. Surgeries, hospital stays, ambulance visits, medical appliances, and drugs are all vastly over-priced. The actors in this: hospitals, drug makers, and appliance makers, among others, have great interest in 
maintaining high prices. Just switching to, “the Federal government pays” doesn’t fix all the fucked up prices, incentives, and wrong things that are being done.
One thing to understand about single payer is that it can be used to fix hospital and other prices. You make the government a monopoly buyer of health care. The government sets the prices, period. “We will pay X. This is a take it or leave it price. No one else can pay you, it’s not even legal for anything that we pay for.”
Now this doesn’t entirely work if you aren’t a hegemonic or at least a “Great Power,” because too much stuff comes from outside and externally applied laws, especially IP laws, impose limits. It is worth it for providers to just stop selling to you if you won’t pay their over-inflated prices.
But if the US does it, and is serious (meaning it will change other laws if required), it can set almost all prices.
“We’re going to give you cost +5% profit over inflation. And that’s it.”
To do this properly, the next thing you do is have some hospitals run entirely by the federal government so they know the actual price structure. You also have the government do some drug and device design+ manufacturing. This is so you can’t be snowed about cost/price.
This isn’t just on-shoring production; it is having the government do the work itself. This also includes research: Some is done in-house — and not at universities or private firms, again so you can directly observe what the actual cost is and what the processes are. (Universities are terrible actors when it comes to research, often taking 80 to 90 percent of the money that supposedly goes to researchers as “fees and rent.”)
It does not matter if public drugs, hospitals, appliances, or research cost a little more or less, the function isn’t to be the “cheapest” — the function is to make sure government knows how things work and can’t be cheated by private providers.
You also must break up all oligopolies, monopolies, and cartels, so that no private outfit can control prices and try to challenge you with a “we’ll walk.” There should always be the government plus at least five providers in any reasonably large health care-related industry and if the country is large enough, even the government should have more than group doing it. (In the US, the Veterans Admin + HHS or something + various others).
Nothing that is truly important (vaccines, as the most current example) can be just imported unless you truly cannot make it or learn how to make it. Create a domestic industry. Let other countries do so. IP Laws MUST be amended/broken to allow this and yes, the US has sufficient power to more or less “just” do this. (The EU will be a stumbling block, but they don’t have a veto on the US).
If you need things that must be bought, in effect, in a currency you can’t print, you are not free, and you cannot control prices or outcomes. Pure autarky is not possible right now, but you want as much as you can reasonably get on anything essential.
I see no reason why all hospitals shouldn’t be independent, by the way. No groups, no cartels, etc. This will allow for actual innovation.
Finally, as a general rule, you mandate outcomes not processes (except your payment processes) so that various providers, including those operated by your own government, can innovate. Mandate process and innovation dies.
To summarize: Single payer is used to force all the other necessary changes. “You are paid by us, and only us. If you wish to stay in business you will do what we want done.” To do this correctly, you must truly understand what is wrong and what is currently possible and you must remove any actor with sufficient power to distort information or who will try and enforce any type of veto or a compromise on you (i.e., “everyone else has to make cost+5%, but us.”)
Every other country but the US has big problems when doing this because of how the current world order is set up in terms of trade and IP Laws, and even the US will have trouble even though the current trade regime was its own creation more so than any other entity. But the US retains, for now, more freedom to act than any other country in the world. Only China and the EU, if you consider the EU a country, come close.
Now, understand that this is not a “what I think will happen” post. This is an article setting out what would happen if the US government and the American people were serious about doing Single-Payer / Medicare-For-All properly. It is an “ideal type” which allows you to judge proposals and anything that happens. It can, of course, be used to judge doing things properly in other countries too, with the understanding that other countries suffer constraints the US does not, often constraints enforced primarily by the US and the EU.
May we come to a world where posts like this are well-understood because the actions outlined are being done, and where everyone gets the health care they need at a reasonable price and those who create the future of health care are concentrated on cures and good health throughout everyone’s life, not palliatives, high profit, and just keeping unhealthy people stumbling along as they suffer.
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