It’s all about doctor pay. M4A will not pay doctors enough for the system to look the way most M4A advocates envision it. Right now, Medicare underpays docs, and private patients make up the shortfall. If everyone is a Medicare client, no one is left to subsidize, healthcare compensation falls, and the science nerds become engineers.

The opportunity cost of becoming a doc is higher in the US than elsewhere because we pay all sorts of professionals very well, and there are start-ups starting up all the time. If M4A would pay what private payers are paying, it would work just fine, except for the moral hazard effects of no deductibles or co-pay. But if being a doctor doesn’t pay better than being an engineer, few of our best and brightest will invest in the years of training and apprenticeship the industry requires.

Cutting out the insurance company middlemen will save some money, but it won’t cover the cost of paying American docs what American docs want to make. A little waste isn’t really the worst thing in the world if the money isn’t causing inflation. Just tweak Obamacare so that insurance companies can afford to cover pre-existing conditions, impose an export tariff on drugs so that Americans don’t pay more than Canadians, and continue to march. M4A is way overkill.