Single-payer means exactly that: one payer. The problem we have now is that there are too many insurance companies with too many plans and too many ways you can or can’t be covered. This means that if you and I each visit the same doctor for the same procedure and all the same billing codes are used but we have different insurance then we pay different amounts. Not only that, but the doctor probably collects different amounts from the different insurance company.

Additionally, because of so many insurance companies not all doctors accept all insurance. This means that although there may be 20 doctors in your town that can treat you, if only 3 of them are covered by your insurance then you have a choice of 3, not 20.

Aside: I’ve run in to this personally with dental care. There are about 25 dentists in the town I live in. But only ONE of them takes the insurance I have. And since they fired me I now have ZERO dentists I can use in my town and now have to drive to a town 15 miles away for dental work.

Now instead consider if we had only one insurance company. Now doctors have a choice – to accept this insurance or not. They only have to learn how to deal with one system (instead of hundreds) which means they’ll learn how that system works and have fewer errors. It also means that all patients would pay the same when they visit the doctor (this could mean $0, but I’m not getting into minutia here). And, the doctor would get paid the same amount for a procedure every single time.

In our hypothetical town with 20 doctors chances are that most, if not all, of them would accept this insurance. So now instead of having 3 doctors to choose from you have 19 or 20. Doctors would now have to compete on service to get new business. Yes, that’s right, single payer would increase competition.

Now let’s talk about the other side of the coin: everyone-in.  In my vision (remember, this is MY vision. Don’t blame anyone else for it.) every single person who resides in the U.S. and anyone who is a U.S. citizen regardless of where they live would pay insurnace premiums into this system. It would be a tax (yes, that’s an “evil” word, but taxes are the price we pay for civilization so get over it).  This tax would be progressive where those earn a little would pay a little, and those who earn a lot would pay a lot.

As I mentioned before I’m not getting into minutia so I don’t know what those tax rates would be. But let’s assume for a moment that they were 10% of your income. Sounds high, doesn’t it? It’s not. Let me show you why.

Right now the median income in the U.S. is about $50,000 for a family of four. 10% of that is $5,000.  But the average (sorry, I couldn’t find a median) cost for health insurance for a family of four for a year is $12,700.  I imagine health insurance costs vary far less than incomes so comparing a median to an average isn’t going to significantly skew the numbers.

Another advantage of everyone-in is that everyone is paying into the system so there’s more money available to pay out when people need it. Also, your premiums don’t change if your health does. Just because you got lung cancer from smoking for 25 years doesn’t mean you’ll be charged more. You’ve been paying in for 25 years so now you get the benefit of using what you paid for.

Closer to home, you won’t lose your coverage if you lose your job and can’t afford the premiums. No income means no premiums, but it doesn’t mean no coverage. So lose your job. Or quit your job and start your own business. You’ll still have health insurance.

Since the only way an everyone-in system could be enforced is if it’s run by the government then that’s what we’d end up with. However, I would prefer if that entity was completely self-funded. Whatever money it collects it uses to fund its own operations. It has to ask permission from Congress to raise rates (taxes). And the money it does collect cannot be used for any other purpose. I would even like a restriction on loans – that no loans be allowed either.

I’ve tried to think of some objections that might come up. Here’s what I’ve got at this time:

1. Employees will take pay cuts to pay for this.
Probably not. Most large employers are already paying for a large chunk of health insurance for their employees. Mine pays about 62% of the cost. Even if the cost was exactly the same ($12,700 per year for a family of four) since it’s a percentage of income rather than a fixed dollar amount, and would be considered a tax, wages will adjust, but then so would prices that are a result of the wages. The net effect would be pretty close to zero. The major impact would be loss of jobs for the CEOs of insurance companies. The staff could go work for the single-payer system and would probably be happier since they’d be helping people instead of focusing on denying claims.

2. This will ration healthcare.
Healthcare is already rationed. As my example above illustrated I only have a choice of 3 doctors here in my town. I can’t go to any of the other 17 unless I want to pay 5 times more for a visit. That’s rationing. Single-payer will open up more options for healthcare, not reduce them. This is not about doctors working for the government. It’s about doctors working for themselves and getting payments from the single-payer insurance.

3. It’s socialism!
Yes. And so what? There are some services that belong in the public realm. I happen to believe that health insurance (not health care!) is one of those areas. Again, my vision is not about doctors working for the government. It’s about doctors working for the patient and simply getting paid by a single entity.

4. You’ll kill off an industry
Not necessarily. It will kill off the large-scale insurance companies. But those who are working for them could go to work for the government entity. The notable exceptions are the CEOs who would be crying because they wouldn’t be getting $100 million paychecks. I feel for them as much as you do.

5. The government is inefficient and would waste our money
The administrative overhead for a typical government entity is 5-10%. For the typical insurance company it’s about 30%. Who is more efficient? I suppose if your goal is to make money for stockholders then the private company is certainly more efficient at doing that. But personally I’d rather take that 20% difference and put it back into providing healthcare instead of lining the pockets of shareholders. Also, my vision has the entity as self-funded and does not have unlimited taxing power. It would take an act of Congress to increase funding rates.

6. Doctors will spend more time fighting for payment
Really? How much time do they spend now? Most doctors spend 4 hours per day filing claims and fighting to get paid. Remember, right now it’s the goal of the insurance companies NOT to pay claims. Under single-payer that’s no longer the goal. The current system also has different payouts for the same procedure depending on coverage. Single-payer means a single payout amount for a procedure. The chance of an incorrect payout is drastically reduced.

7. Fraud will increase
In every system there is a certain amount of fraud. Our current system actually encourages it because insurance companies don’t want to pay claims. So doctors will occasionally inflate claims in order to be fairly paid for their services. This happens today already. Insurance companies have people on their staff to help detect fraud and put a stop to it.  With a single-payer system there would also be a fraud detection unit. I would think that it would be easier to detect fraud since doctors can only do so many procedures a day/week/year. If a doctor claimed excessive procedures done then since everything goes through one entity it would be easier to spot. Currently a doctor can file claims with dozens of insurance companies who may not have the entire picture. Personally I think fraud would go down, not up.

8. I don’t want to be forced to do anything
To me this sounds like fear of change. But let’s take it at face value. The only thing you’d be forced to do is pay into the single-payer system. You’re most likely already paying insurance premiums. If so, then the only thing changing is who you’re paying. You’ll have a choice of more doctors. You know you’ll have coverage even if you’re out of work. You know you’ll have coverage even if you get really sick. You know you’ll have coverage if you have a child with Down’s syndrome. So what’s really being forced on you is less risk, more choice, and likely lower cost. Is that a problem?