Hospitals would receive global budgets, negotiated annually on factors like the size and needs of the population served. The make-up of the administrative board could vary by region, and needn't be dictated federally. There should be a range of options and mechanisms for patient and physician involvement to assure public accountability and acceptability. It is important for us to lay out the principles that should shape a national health program, and sketch some of the structures and governance. But it would be a mistake to dwell on administrative details.
Unions are useful in many respects.
We do need collective action, and unions are one model for that, but they aren't sufficient. We need collective action that works with patients. The United Auto Workers union didn't stop GM from building unsafe cars for generations. Too often, physician unions work on very narrow physician interests. The latter is seldom an issue.