Marilyn M. Singleton, MD, JD
As healthcare costs continue to rise and many remain uninsured, a national single-payer program has been proposed as a remedy. Americans have not embraced single-payer despite more than 80 years of earnest advocacy from Washington and, more recently, the states. Government is responsible for almost half of healthcare expenditures but has been unable to halt rising costs. Predictably, healthcare costs will increase as the population ages. Although single-payer proposals offer generous coverage at no direct cost to patients, there is no mechanism for cost containment, and financing via tax increases is unpalatable to the electorate. Moreover, patients overwhelmingly value and want to keep their personalized medical care. Curbing special interests’ political influence and redesigning the private market may achieve the goals of maintaining a trusted patient–physician relationship, portability, increased access, reasonable prices, and special attention to the vulnerable.