It's a very good question. It's why M4A was always a pragmatic centrist compromise, when really to get maximum efficiency you need an NHS. It's weird that Romneycare ended up playing the part of the radical communist bugabear for the right as premiums skyrocket and more profits are being made than ever. VA hospitals for all would be the real lefty dream.

If the government is the only payer, they can squeeze the excess profit out of the system year over year.

"Hey, we noticed you pay your executives $25 million a year. We decided to cut the executive pay allowance this year."

"Hey, we noticed you're paying your shareholders 50% of your revenue. You seem pretty profitable, so we're cutting your reimbursement rates for all procedures this year."

Such a system is eminently practical. What's not practical is the current US system.

Non-profit hospitals still charge normal people insane prices for nothing. Non profit does not insulate us from predatory practices.

Hospitals want to grow and want to stay solvent (regardless if they're for or non-profit). $400 Ibuprofen it is!

Price transparency is one solution for this.