> And that solution is unlikely to have much impact on costs. How do you reach that conclusion? National health insurers almost always pay less item-for-item

> And that solution is unlikely to have much impact on costs. How do you reach that conclusion? National health insurers almost always pay less item-for-item than private plans, because they represent a large proportion of income for healthcare providers and thus have immense bargaining power. Medicare, for example, pays less for medications and procedures than almost anyone else. There's no reason to believe they wouldn't get an even better deal if more of the population was under their coverage.