A Single Payer system is basically socialized medicine as has been implemented in Canada, the U.K., and numerous other countries. With a Single Payer system, there are no insurance companies. The government is the single payer of healthcare expenses for each individual (less, of course, a deductible that may be based on income). It is hard to imagine a Single Payer system working effectively in a country as large as the United States.
The cost of building and maintaining the management infrastructure will likely run in the trillions of dollars, and managing the quality of service will be a nightmare. As much as the threat of malpractice suits drives up the cost of healthcare, it does serve the purpose of helping to maintain a reasonably good overall quality of care. Regardless of whether a good job of implementation can be done, the insurance industry and politicians who are supported by insurers would never allow a Single Payer system to be set up.
In my humble opinion, the best solution is to stick with an Open Competition model, but make a few changes that could help those who are under-insured receive some benefits. One is to provide additional tax credits to employers who insure every employee. Businesses already are allowed to expense their health insurance plans, but providing them a bonus for insuring all (including part-time) employees may increase the number of people that have some sort of health benefits. Another is to provide insurers with a tax credit for insuring people who are uninsured, but who donâ€™t qualify for Medicaid.
Tax credits for companies that take steps to provide insurance to those who canâ€™t afford it are a better solution than building a large socialistic infrastructure on top of the ones we already have (i.e., Medicaid, Medicare and state programs).
The next time you hear a candidate yapping about healthcare reform, try to figure out into which category his or her plan falls. In most cases, it will be some form of Managed Competition and there will be little real difference between what each candidate proposes. You may see an also-ran propose the Single Payer option, but itâ€™s unlikely heâ€™ll have a workable plan on how to implement or fund it. Regardless of whatâ€™s proposed, I suspect that weâ€™ll have a form of Open Competition for a long time to come.