> Some providers are more efficient then others so a statement that medicare reimburses below cost is not accurate. Maybe some procedures reimburse below cost but not all do.

I never said all do - I said that in aggregate, Medicare reimbursements are 7% less than COGS. "Efficiency" doesn't really enter the picture, because COGS isn't driven by efficiency (ie, overhead); it's driven by upstream costs.

> So logically it is better to employ more residents if you have sufficient patient load since it would reduce COGs.

Nope, none of the stuff you mentioned falls under COGS.

> One could argue that medicaid and medicare patients are sicker and there are more of them than most so they provide a larger revenue stream than private insurance covered patients (and they also require more procedures)

This is the classic "we'll lose money per customer, but make it up in volume" argument.