> Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
Emergency rooms operate by triage. If you're having a heart attack, you're going in right now. If your shoulder has been bothering you for six months, you might have to come back multiple days in a row and spend the whole day waiting before there is a slow enough day that you can be seen. There is then an obvious incentive to go pay a private physician to be seen immediately instead. Free clinics are similar: There are no appointments, it's first come first served, and then most people prefer to pay $100 to schedule an appointment rather than wasting an entire day waiting in a queue, but you still have that option for people with no money.
Emergency rooms are also a natural monopoly because in an actual emergency the primary consideration is which one is closest, which doesn't make for a competitive market. So it makes sense to have the government do that. Whereas non-emergency care (which is the large majority of medical expenses) would allow people to compare prices or make cost trade offs against distance or convenience etc., if we would actually expose people to pricing. For example by requiring price transparency and then having insurance pay the second-lowest price for that service within 100 miles of your location, but then letting you choose where you actually want to go and make up any difference yourself, or choose the lowest cost option instead of the second lowest and then put the difference in your HSA.
> A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence.
It's not clear how a government option that doesn't have taxpayer subsidies would do this any better than a private non-profit. There are many existing non-profit healthcare providers and they don't have meaningfully lower costs than for-profit ones.
The general problem is that "non-profits" and government-operated services still have money flowing through them and "profit" can be extracted in all manner of ways other than paying dividends to shareholders. The officers can just pay themselves high salaries, or whoever is in charge of the budget can take bribes/kickbacks to shovel money in the direction of the contractors or unions paying them off.
Meanwhile the nature of "profit" in a competitive market is largely misunderstood because of accounting differences. If a non-profit wants to buy an MRI machine, they have to take out a loan, and then pay back the loan with interest which they account for as an expense. A for-profit company might get the money to buy it by selling shares to investors, and then paying dividends to the shareholders instead of paying interest on a loan, which goes on the books as "profit" instead of interest expense. But you couldn't just replace them with a non-profit and then lower prices by the amount of "profit" they were making because then they also wouldn't have had private investment and you're back to needing the loan and paying the same money as interest to the bank.
The thing that requires providers to be efficient is competition, because then the ones wasting money or taking bribes have to cover the amount wasted/embezzled by charging more to customers and then the customers don't choose them because they have higher prices. But that's the thing the existing regulatory system goes out of its way to thwart.
