Now I feel like a Dick. The items you listed are also problems. Insurance companies will not just curl up and die if single payer happens. However, they will be forced to change. Hospital ceos also wouldn't join the middle class. There will still be plenty of money in health care, even if these people become state employees. I just wish insurance companies acted more like union leaders than corporate cronies. Unless you are a board member, my distaste in directed at you.