I clapped for your comment because Medium advised me that this would give better visibility to our conversation. This time you are wrong almost at every sentence you wrote.
I would call an “Ayn Rander” someone who adopted her philosophy after reading her books. I arrived with the same conclusions twenty years before learning about her writings.
Formally, we still do not have a single payer system, but competition is almost none; hence, practically, we do.
Medicare is prohibited by law from negotiating drug prices; this is just one example how promoted by you a single payer system works.
According to my sources private insurers pay the same rates as are on the Medicare price list with variations no larger than up or down 20%. Simply, you have a strong opinion but weak data.
Your opinion what is on my mind comes from your a priori condemnation of my point of view not from your understanding of it. Disconnecting medical services from ability to pay can be done only in abstraction.
There still will be better and worse hospitals; those who can afford to pay bribes will stay in the better ones.
There will be better and not so good doctors; those who can afford to see a good doctor outside of the system, will get better care.
There will be treatments that due to price or physical restrictions can be available for the very few only. Now those who can pay have priority access. But their high fees pay for research and development of new treatments, which gradually become commonly available. With your approach, again, those who can bribe the system will get better care, but the financial incentive for developing new treatments will diminish. In result there will be a fewer new treatments and our access to them will be harder.