How would Medicare for All Work? Medicare today is viable because people have paid 30+ years into

[DeminPennswoods]

66. Here in PA, a BCBS in central PA was sitting on billions

of dollars in cash. I remember Rendell making that a point of his campaign for governor to make BCBS spend it on care.

I've been dealing with insurance companies for the past decade while navigating the decline and passing of several relatives. I've gotten plenty of coverage denial letters and made my share of phone calls trying to explain why whatever was denied should be covered. I'm sure it's 10x s worse for doctors, hospitals, rehabilition and nursing homes trying to get reimbursement. IMHO, it's the biggest reason the US health care industry is so expensive and inefficient. Those experiences have convinced me that insurers deny claims when they can and count on the insured not to go through the hassle to fight the denial and just pay out of pocket.

While insurers are regulated, that doesn't mean they don't use every tool they have to pay out as little as possible.

I recall insurers howling when the ACA upped the percent of premiums that had to spent on care to 80% and 85% (large markets). Just for comparison, medicare's overhead is, iirc, 4%.