The core appeal of the 2020 Democratic presidential candidate’s Medicare for All proposals, whether it’s optional buy-ins floated by moderate Democrats or Sen. Bernie Sanders’s comprehensive single-payer reforms, is the notion that enormous savings could be generated by dispensing with private insurance. Advocates claim that that insurer profits, as well as costs associated with managing risk and advertising plans, could be dispensed with, and that hospital fees could be greatly reduced by imposing Medicare rates, which are 40% lower under the M4All plans.Yet, it is notable that no such savings ever have materialized—even under the most propitious of circumstances.