When I say things like that to my Canadian friends, what I mean is: “I am not confident in the ability of the government to implement a reasonable single payer system. I am concerned that regulatory capture, small government politics, and special interest groups will result in system that is worse than what we currently have.”

You had mentioned hospitals being incentivized to reduce costs. They could do that by avoiding sick patients. Or not treating sick patients.

Some “providers” already have this business model.

Also, it’s all but guaranteed hospitals would seek to increase revenue by providing non medical services at high expense.

$2000/meal. $500/night parking. $500 for a hospital gown.

America needs to address its weak administrative state, underfunded and under-qualified civil service, and overall shitty public sector before taking on a massive project like this.