Single Payer Train

Are we being steered toward a single payer health care system? Some believe that is the case. While it may be true that some in D.C. want a single payer system it is a system with a 100% failure rate.


I am not saying our current system is perfect but it works better than any other nation wide health care delivery system.


Jeff Greenfield ponders if a single payer system would be less vulnerable if SCOTUS rejects all or part of Obamacare.

Let’s begin by imagining that Congress and the president decided to adopt a genuinely radical health care plan—the kind in place in most of the industrialized world. They decide on a  “single-payer” system, where the government raises revenue with taxes, and pays the doctor, hospital and lab bills for just about everyone.

In essence, the federal government decides to nationalize all aspects of health care, making it a big government bureaucracy.  Keep in mind this goes way beyond the way Medicare and Medicaid currently work. Yes, those programs are funded by taxpayer dollars, but they are not really single payer in the true sense of the word.


Private contractors (medical personnel, hospitals, durable goods providers, etc.) choose if they want to participate in the Medicare/Medicaid system or not.


A true single payer eliminates private industry. The government decides how much to pay the provider and what services are expected. The British NHS works like this and you know how well that works.

So why is Obama’s health care plan, with a far more modest use of government power, in serious jeopardy? It’s because the key element in the plan—the “mandate” to purchase health insurance or pay a penalty—was not based on the taxing power, but on Congress’s power, under Article I, Section 8, to regulate interstate commerce. And that power, while broad, has its limits...even if those limits are murky. 

The mandate, the requirement of all citizens to purchase health insurance or pay a penalty tax, is extremely unpopular and rightly so.


The article seems to justify their position on the mandate by linking to a report that Gov. Romney was in favor of a mandate in the Massachusetts health care experiment.


While true, that is only part of the story. Forbes contributor Avik Roy has this review of how the Massachusetts experiment morphed from what Gov. Romney wanted to a giant cash eating monster.

Romney individual mandate was designed to require catastrophic insuranceRomney’s big idea was to free insurers from the state’s costly 1996 insurance mandates, allowing individuals to buy inexpensive insurance that would meet their most urgent needs. But the health law he signed in 2006 did not specify the types of plans that insurers were required to offer. “The specific definition of [minimum creditable coverage under the mandate] was left to the board of the Health Connector to decide,” recounts Josh Archambault.

Romney’s goal, with the individual mandate, was to require people to buy catastrophic insurance that would cover emergency care. Romney’s version of the mandate was designed to compensate for the effects of the federal EMTALA law, that requires hospitals to provide emergency care to everyone, regardless of their ability to pay. 

Catastrophic coverage, especially one stripped of all the costly mandates implemented under the Dukakis administration, is much different from the plan Democrats put in place after Romney signed the bill in to law.

In similar fashion, the Obamacare law that was signed in 2010 was so ambiguous and arbitrary in some sections as to allow broad interpretation and implementation subject to the whims of the HHS Secretary.

We have seen how dangerous this can be, both in Massachusetts and nation wide under Obamacare.

Is Mr. Greenfield right? Would Obama have done better to nationalize health care and avoid the Constitutional challenge?

I hope that option is never up for consideration.