Comment by rqtwteye

"insurers are more innovative (especially on the operations side and post-ACA) than the federal government."

They are certainly very creative in making the system as expensive as possible. See Medicare Advantage.

"IMHO, best of both worlds would be the federal government taking over and centralizing the most core services (rates, interchange, data systems, etc) and allowing private insurance companies to build offerings on top of that (customer service, servicing, product mix, etc)."

This would be best. There is so much unnecessary bureaucracy at providers and insurers because the insurers have different setups. The medicare setup would be a good foundation .