Red:
See, that folks have any concern over that happening strikes me as ridiculous. What is Congress going to do? Pass a law prohibiting firms from offering health insurance? I seriously doubt it. Thus so long as firms can offer health insurance, some will find a profitable way to do so and, in turn, offer it.
Consider water. Pretty much everywhere one goes, there's free potable water available, and it's provided by firms holding governmentally sanctioned monopolies.
Do firms yet offer water? Damn skippy, they do, and they make good money doing it, from the individual bottles to multi-gallon dispensaries. Indeed, not only are there sellers of "basic" water, there are too sellers of flavored water,
i.e., differentiated water; moreover, of course,
one doesn't even need to actually use "city water" to supply one's basic water needs.
When one thinks about so-called "Medicare for All,"
i.e., health insurance, in terms of what that really means -- converting the health insurance market to that of natural monopoly -- a wealth of options open up and the question becomes one of apportioning insureds among the providers (if there're more than one) all of whom provide an undifferentiated product that provides whatever be the minimum level of coverage the citizenry demands.
In what context may one think of "minimum level of coverage?" Well, electricity distribution, yet another natural monopoly, provides a fine example. When one retrofits an old home with, say, an induction stovetop, one of the things one must do is have the electric company, effectively, move one from the electric company's version of a "lazy stream" to a "babbling brook" (i.e., drop a line having more amps) so the flow of electricity one receives comports with what the induction stovetop needs. Of course, some buildings sit on what one might think of as "white water rapids" and others on a veritable "waterfall."
Using the above analogy with regard to "minimum level of coverage," one sees that another aspect of Medicare for All (natural monopoly health insurance provision) that can be managed in a variety of ways is the amount of coverage one buys, recognizing that like electricity, everyone's gets at least coverage that pays for for a defined bundle of procedures and remedies. That's just like every home having at least a 30 amp feed from the electric company. People who want to can buy "more flow," that is, more coverage, either from Medicare or from private insurers.
So what I'm saying is that one must think about the matter, not in terms of what one's used to -- most especially, but not only, the word "Medicare;" simply replace it with "health insurance" -- but rather in terms of the product being offered, the market structure in which it's offered, and the design of the product itself. Then one can begin to brainstorm
natural monopoly (health insurance for All) health insurance delivery models.
Lastly, one should also disabuse oneself of the notion that the government is incapable of operating a profitable and efficient business-style entity. The federal government operates the USPS, and it does so without a single tax penny, and
its performance at delivering "as advertised" is amazingly good. That is why, for example, during the shutdown, you continued to receive US mail delivery. The USPS isn't the only self-funding government unit. So is the Federal Reserve, which is why banks stayed open. (The only reason banks close on government holidays is because their bank, the Fed, is closed.) There are
several other self-funding federal organizations.
Note:
If you haven't a strong economics background, I suggest you click on the "natural monopoly" link above and consume the content found on the linked webpage. Although the word "monopoly" is there, natural monopoly is a very different thing from a monopoly firm such as Standard Oil.
eace