> can negotiate prices down by 50-60%

You can only do that by paying Doctors less.

Good luck with that. If you did it anyway, good luck finding enough Doctors.

When people think "negotiate prices" they usually think of drugs, but Doctors is the real problem.

Medi-Cal (and Medicaid in general for all states) only works because the regular rates subsidize the under-market charity rates. That only works up to a point, then it doesn't.

That BTW is why hospitals never publish rates - they need the higher rates to subsidize the charity rates.

Until you change that, you will never have single payer, it's impossible to do.