Ok, that makes sense! I hadn't carried the thought experiment far enough. I'll be sure and pick their brains next time I see those folks.
I'm curious to hear their opinions. I've got a few different angles into the healthcare industry but not all of them are current, and not all of them are universal. Rhogam, for example. If we do eight babies a month, that means like two to six shots of rhogam. We keep our rhogam in a monitored, audited fridge whose temperature I can check on the Internet, that sends me and my wife texts when things deviate. And I can cobble stuff like that together now. We keep it in our "vaccine fridge." but our "vaccine fridge" isn't nearly robust or large enough for a state-sponsored vaccine program - outs is an under-the-counter Haier rather than a $8k walkin. And when we order Rhogam we order it per shot, because you get it per shot or per 100 and there's no way we can burn through $2100 worth of Rhogam before it expires. A hospital maternity ward? They got the walk-in vax fridge, they got the pallet of rhogam, they got the economies of scale. But then, they get the same facility fee we do (according to Medicare) despite the fact that their overhead is 10x what ours is. No solution is perfect. With single-payer, though, everybody involved gets an input. With the current system it's whatever the insurance companies can get away with until laws are actively passed to keep them from boning everyone.