The Problem with Single-Payer Plans‪.‬

Many liberals in America dream about single-payer plans. Even if they acknowledge that a single-payer plan cannot be enacted, they still think it the best reform. Another proposal may be politically necessary to achieve universal coverage, but it would be a compromise, a fall-back. Single payer is the ideal. This is wrong. Even in theory, single payer is not the best reform option. Here's the problem: while it proposes the most radical reform of the health care financing system, it is conservative, even nostalgic, when it comes to the broken delivery system. It retains and solidifies the nineteenth century, fragmented, fee-for-service delivery system that provides profligate and bad quality care. Reform of the American health care system needs to address problems with both the financing and the delivery systems. As proponents of single-payer systems note, the financing system is inequitable, inefficient, and unsustainable. There are now forty-seven million uninsured Americans, about 70 percent of whom are in families with full-time workers. Wealthy individuals receive much higher tax breaks than the poor, and insurance premiums are a larger percent of wages for those working at low wages and in small businesses. Many working poor and lower middle class Americans pay taxes to support Medicaid and SCHIP, yet are excluded from these programs. The employer-based and individual market parts of the financing system are inefficient because they have huge administrative costs, especially related to insurance underwriting, sales, and marketing. The government part of the finance system is inefficient because it fails to address key policy issues, fraud, and--for Medicaid--complex determinations of eligibility. Over the last three decades, health care costs have risen 2-4 percent over growth in the overall economy. Medicaid is now the largest part of state budgets, forcing states to cut other programs.