Reply #34: I was looking for someone to bring this up.

[nbsmom]

Single payor in theory is a great idea.

Single payor in practice is going to take a lot of time, patience and probably more than a little bit of $$$ to get it going.

And the most fundamental concern (to me at least) is who does administerthe program? The government self-funds, but each state in effect becomes the payor? This would provide the large pools that share the risk and make it more affordable, but also limits any huge bureaucracy and waste.

Where the Clinton plan did hit some bumps IIRC, was around
1) who plays gatekeeper role?
2) what is a fair reimbursement (I've posted this elsewhere, but Medicare's reimbursement is NOT state of the art by any means...)
3) where does the $$$ get collected?
4) Do you build up HCFA or do you create a new agency?
5) Is it really wise to blow off some quite promising programs currently available in the private sector?

And, while I'm up here on my soapbox, please don't lump all HMOs and health plans into one greedy self-serving bucket. Kaiser and the NFP Blue Shield and Blue Cross plans have done some amazing things, without a great deal of fanfare (or blimps.)

I really, truly encourage you to look at the legislation currently in play in CA. There's the one that was recently passed and signed
http://www.leginfo.ca.gov/pub/bill/sen/sb_0001-0050/sb_2_bill_20031006_chaptered.html
and then there's Sheila Kuehl's bill. http://www.leginfo.ca.gov/cgi-bin postquery?bill_number=sb_921&sess=CUR&house=B&author=kuehl
Both are promising steps toward what we need to accomplish in this country.