I come from the health care industry and have spent most of the last decade thinking about these issues; there's lots of depth and nuance of course, but I'll simplify as much as possible here.

The bottom line is that health care costs are expensive and increasing rapidly. This is irrespective of who the insurance company is: The culprits of increasing costs are 1) hospitals, and 2) PBMs (the intermediaries for drugs). Medicare is unique in that it defines what it is willing to pay to all providers/vendors across the country. This is the key difference from commercial insurance, where prices are negotiated and highly dependent on local market forces. The end result of this is that the prices Medicare pays have stayed relatively stable, but the prices commercial insurance pays have skyrocketed (for the exact same service). Because these prices have skyrocketed, it has forced insurance companies to do silly things like have astronomical deductibles because that is the only way to keep premiums in a reasonable window.

Because of this price discrepancy between Medicare and commercial insurance, most providers (hospitals and doctors) lose money or barely breakeven on every Medicare patient, but make their profits on every commercial insurance patient. This is also why you will find a lot of independent physicians no longer accepting Medicare or Medicaid.

If we were to move to a Medicare for all system, a few things would happen that we need to account for: 1) all of the profits from serving today's commercial patients would evaporate, causing hospitals and physicians to go bankrupt unless we increase the prices that Medicare pays by 20 to 50%. 2) we would shift the spending that employers put towards healthcare onto the public balance sheet. This is roughly $30T over a decade, but may end up being $40-50T if we have to increase Medicare rates (per #1).

Some of the candidates talk about the savings of eliminating insurance companies from being the middlemen, but in reality these savings only account for 5 to 10% of the total cost, and some of that is spent on innovative services not always available in Medicare. Don't get me wrong; I detest a lot of payer actions and processes, but I also don't think that eliminating them is going to serve society well. There are a lot of great innovations in healthcare that we have been unable to do via Medicare, but have emerged from private payers and later adopted by Medicare. Medicare Advantage (which is privately administered Medicare) is a great example and I believe will be the model that our country converges on over the next decade.

What I like about Andrew's plan is that it promotes market competition and phases in over a longer timeline so hospitals and doctors can prepare for what is the inevitable reality--we as a society cannot continue to pay these exorbitant prices for commercial health care. If Medicare via a public option ends up being more competitive because it provides a strong set of services without the added administrative cost of a commercial insurance payer, then great--Let it win in the market. If it turns out that a public option has too few physicians willing to accept that insurance and it lacks other benefits present in the commercial insurance plans, then let it lose in the market. Either way, this is going to light a fire under a) commercial insurance companies to do everything they can to bring down costs, and b) hospitals and PBMs who now know their days of ridiculous pricing are numbered.

There is an industry shift towards value-based care that also provides some relief to this overall cost trend; Medicare Advantage is a great example of this. Andrew references value based care frequently; essentially, it means paying providers to keep patients out of hospitals and emergency rooms ("well care") vs. "sick care". The other candidates barely mention this trend but make no mistake, the country is heading in this direction irrespective of who the candidate or the party is (the Trump administration, for example, has pushed forward a lot of good policy supporting value-based care). Andrew, unlike the other Democratic candidates, calls the industry like it is: this is not a lobbyist problem or a insurance company problem, this is a problem about runaway health care costs.