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Single Payer – what’s the real scoop?

(this is an update of a post from last year; given all the attention, it’s timely) It’s the worst kind of government over-reach.

It’s an easy solution to a huge problem that will cost nothing.

And everything in between. Between now and Election Day you are going to hear a lot about Medicare for All and Single Payer, and most of it will be utter nonsense.

Proponents of Single Payer/Medicare for All say it will reduce overall costs and ensure everyone in America has great healthcare; At the other end of the spectrum, it’s fiercest opponents say it will bankrupt the country while giving bureaucrats control over your family’s healthcare.

Reality is, since there is no actual agreed-upon “Medicare for All” or Single Payer legislation, each of us sees what we want to see – MFA as the Holy Grail or a Total Disaster.

Let’s take a step back and think about how voters are affected by the core problem – or rather problems, with healthcare and health insurance.

The focus on voters is critical here – most are covered by employer-based health insurance, and most of the rest are covered by Medicare. For the non-elderly:

  • Health insurance is stupid expensive.
  • For many of us, deductibles are so high “insurance” just protects you from catastrophic injuries or illnesses.
  • Insurance companies control the doctors and hospitals you can use and the care you get.
  • The paperwork is mindboggling, confusing, and adds billions in unnecessary cost.

For workers, healthcare “costs” are a combination of insurance premiums and cost-sharing payments – mostly deductibles and copayments. (While about 75% of premiums are paid by employers, economists argue that most of those premium dollars would be paid in cash wages if health insurance wasn’t provided.)

Today family health insurance premiums are more than $20,000 a year.

Over the last two decades, healthcare costs have eaten up wage increases – one of the main reasons families aren’t getting ahead.

For those who actually have to use their health insurance, it’s worse. Deductibles are so high that many families can’t afford them.


Add this all up, and you understand why healthcare was the top issue for most voters in the mid-terms.

Voters like simple answers to complex questions – and for many, some form of Single Payer sounds great.

The takeaway – voters want healthcare solved and they don’t care much about the details.

4 thoughts on “Single Payer – what’s the real scoop?”

  1. Thanks Joe. I would disagree that voters don’t care much about the details. Voters agree that our healthcare system is broken; however they don’t agree on how we fix it. Over 90% of those polled by Hidden Common Ground agree that we need to make healthcare more affordable; we need to lower the cost of prescription drugs; we need to insure preexisting conditions; cover long-term care; and improve accessibility to providers. We are; however, deeply divided on the details of how we get there. As is so often the case, It comes down to voters comfort level on how large a role the federal government should play as we move forward.

    1. Well Said Fred, and most voters may also not realize that even with many government sponsored plans, such as medicare/medicaid, much of it is actually administered by private companies (the same ones that often administer the group health plans), As such, many of the administrative issues highlighted or the inherent costs of plans would not change, we would simply shift the names and players, but the game would be the same. Could you imagine telling someone with back pain or knee pain they cannot have an MRI for months (in some cases years) or that they need to wait ~5 months to see a specialist or have a surgery (which may actually not be such a bad thing though we need to stop wanting to have our cake and eat it too). We cannot have “free” healthcare and still have a system of benefits that we currently have, albeit as Joe notes perhaps many would not agree that the benefits we now have are that great anyway, further proof the real issue is defining the problem, defining the meaning of proposed solutions, and agreeing on what we are willing to compromise. As a leader I know says “there is no free lunch”. I am not advocating for one way or the other (or as Joe so rightfully indicates the one million variations in one direction versus the million variations in the other direction), rather I am like most americans and stuck somewhere in the middle of the political spectrum, at times leaning a bit to the left and other times a bit to the right, and in the end frustrated with the way both “sides” spin the position to suit their needs and ultimately simply spinning in circles and not getting anywhere. My takeaway, I hope that we can start calling a duck a duck, and not coming up with all of the creative tactics that at the end of the day do not really solve the underlying problem. Changing the way we address a symptom does not fix the underlying issue, and so far the underlying issues are not as newsworthy, which of course is a whole other problem.

  2. “The paperwork is mindboggling, confusing, and adds billions in unnecessary cost.”

    Our health system has a business office of over 300 just to get charges posted, claims paid, and cash posted. Mindboggling is right!


    1. If there was an all payer fee schedule and evidence based medicine standard you’d only need one.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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