There may be alternatives to a single payer system.
While the math of the single payer system could work (http://healthaffairs.org/blog/2017/05/11/the-bipartisan-single-payer-solution-medicare-advantage-premium-support-for-all/). It is very likely that the implementation of such a plan would look and feel like Managed Care. Even if Congress manages to overhaul the tax codes or require the employers to pay the premiums to the government to fund the care, it does not really solve the cost, quality, experience and overall population wellness and health improvement challenges. The existing managed care organizations haven’t achieved these goals so far. The experience continues to deteriorate. More regulation, more administrative burden and more thoughtless application of technology cannot solve the underlying gaps in accountability that cripple our healthcare system that is also slow in adopting lower cost high quality innovative solutions.
Individuals are increasingly shopping for healthcare services, the providers must woo their patients with high quality services. The convenience of concierge services with a combination of high deductible plans increasingly provide more value and better experience. Employers are decreasing their share of the premiums and passing the increasing cost of premiums to the employees, they are also offering mostly low premium high deductible plans to limit their share of the premiums, some are also moving to defined contribution plans. Others are piloting direct contract with leading providers in their local geographies. May be, to lower costs let us try freedom (https://mises.org/blog/lower-health-care-costs-try-freedom);
It is key that we sustain the safety net programs. According the National healthcare Expenditure report, the combined Medicare, Medicaid spend for 2015 was approximately $1.18 trillion, the combined Medicare, Medicaid population (including the Medicaid expansion population) for the same timeframe is approximately 130 million. Is it possible to run a VA –lite like program for the Medicare-Medicaid population with this kind of a budget? Discontinuing the path of different permutations of payment reform, maybe we should consider care design and delivery reform as an alternate public-private partnership. A number of states offer tuition grants for qualified professionals in specialties (e.g. mental health) that have shortage of these professional with the requirement that they serve in this hospitals; we do see military tuition assistance programs.
It is highly likely that when individuals have more control over their health care spending, they will chose their health insurance coverage requirements based on their personalized needs and maintain healthier lifestyles. Would we then need individual and employer mandates to mitigate the cost impact of high risk pools?
The role of the regulatory agencies should be to independently establish and enforce safety and quality standards.
Finally, we would still need catastrophic insurance for life’s unpredictability. But that is precisely the purpose of insurance.