It's been my vague notion that Medicaid comes through on big ticket items, but isn't very good at providing routine and wellness care. Even if that's wrong - it would certainly need to be modified drastically in benefits and operations to do the "public option" as most of us interpret the term. Yes Medicare-for-All-Who-Need-It could be more efficient. It needn't have the full range of benefits that seniors get. It just needs to provide basic care to those who aren't getting it and protect the working and middle classes from bankruptcy and it would soon be a very popular program.