> Similarly, private equity is the same people with the same incentives as Enron, Toys R Us, Sears, and other major collapses

Right, and the key difference is that there are several other options for all of those things. When private enterprises become unsustainable, they go out of business. When government programs become unsustainable, we increase their budget. With private enterprises, it becomes possible for other alternatives to be introduced in parallel — neither Enron, Toys R Us, nor Sears are monopolies, and with their demise, we still have plenty of energy, toys, and retail. That's not the case for government endeavors.

That said, many countries have solved this problem through the provision of competing state-owned enterprises (state capitalism), which are often traded on public stock markets. This is pretty common in the Scandinavian countries, as well as the East Asian Tigers.

> I'm not sure government is worse at health care than private industry when we are talking about care for the bottom X% (25%?) of society that can't do private payment.

As we all know, there are several countries that are able to pay for care in a way that the government is the monopoly payer (i.e. single-payer), but there are also countries that are able to pay for care in a way that there are multiple payers, with similar (if not better) outcomes. Switzerland and the Netherlands both have purely private health insurance systems, and there's no sign of that changing any time soon, and both enjoy excellent health outcomes with broad approval of their respective healthcare systems (https://www.forbes.com/sites/theapothecary/2011/04/29/why-sw...).

Even in the US, we're essentially running this A/B test with Medicare (ironically). When you turn 65, you have the option to enroll either in "Original Medicare", which is what we usually think of when we talk about "single payer healthcare in America", or you can enroll in Medicare Advantage (aka Medicare "Part C"), where the premiums that would go to the CMS instead go to private insurers like Humana, United, Oscar Health, Aetna, Clover, etc. These plans replace Original Medicare.

- 48% of Medicare beneficiaries are on private Medicare Advantage plans instead of the public "Original Medicare". Because everyone is entitled to "Original Medicare", this is purely voluntary. This number has been growing so rapidly that the CBO projects that by 2023, the majority of beneficiaries with choose the private over the public option. The CBO further projects this proportion to increase to 61%(!!) by 2032. (https://www.kff.org/medicare/issue-brief/medicare-advantage-...)

- For most beneficiaries, Medicare Advantage costs about 40% less than Original Medicare and are, on average, of higher quality than Original Medicare (https://healthpayerintelligence.com/news/medicare-advantage-...)

- In Urban areas, Medicare Advantage costs less per capita to administer than Medicare — and that's not including the extra Medicare Part D insurance that you would have to buy if you're on the Original Medicare plan (https://www.commonwealthfund.org/publications/issue-briefs/2...)

I personally don't think one is necessarily better than the other (single payer can have good outcomes!), it's just that each have trade-offs that optimize for different things, and it's up to societies to decide which of those trade-offs they prefer. The US has, unfortunately, chosen the worst of both worlds, given that our health insurance market is heavily distorted by the government, and the welfare system that underpins it is inefficiently distributed.