I don't want the government as a single payor. Medicare fraud and administrative waste are horrendous. If you change your practice address, Medicare holds up your payments for months. "HCFA-for-all" is exactly what the problem doesn't need.
The patients need to be involved in, and at risk for, payment for the services they receive. Everyone who is not living on the street can pay something. For the employed, the best model might be an HSA, where the patient "owns" the first several thousand dollars of the premium, to spend as they need and desire, and beyond that is covered by insurance. Some of my patients have this, and they aren't demanding chest x-rays and MRIs for every complaint, or asking me to write them a medical statement to continue their expensive brand-name sleep med.
The less fortunate will need some type of subsidy for the patient-controlled portion, but there must be some patient ownership of the payment process, and some risk. Only then will patients look for physicians, hospitals, etc, which can compete by efficiency, quality and value. The role of the government is ONLY to provide clarity on prices, ratings (not by insurers, but by other patients and professionals), all the info they need to choose. It wouldn't be that hard to get something like this operating on a small scale tomorrow, Mr. Obama.
What we have now is a system like what caused the sub-prime mortgage meltdown -- our patients are buyers with nothing down, nothing to lose.
