As a favor then, could you summarize or make more easily understandable the PDF of the alternate plan you linked to? I, and I'm sure many others, just don't have the time in a day to wade through an 80-page policy paper.

 I think this is exactly what Krugman was referencing. It's much simpler and politically expedient to say "I support single-payer" than to launch into an hour long policy discussion on a tiered-system that merges government and private sector insurance.

 This is a problem across the Democratic Party. We're great at hour long policy discussions and 80 page white papers about complex policy initiatives, but we SUCK at getting our message across in less than 30-seconds.

No plan is perfect, you are right. But in the case of something like health care, simpler is better. not only politically, but fiscally. Yes, the transition costs at first may be higher than the graduated, tiered system (or another solution). But I think Americans are SICK of the complication and cost of our system and just want something simple that will cover them and lower the insane amount we spend per capita on health care for less coverage.

And who says that a single payer plan will eliminate private sector insurance? An Industry will pop up right away to serve people who want additional coverage on top of the government coverage (add-on plans for more services covered, longer term disability coverage, etc ). Any single-payer plan should take into account secondary "add-on" insurance for those who want it.

heck, it doesn't even have to leave Union negotiating! There could still be much scaled back employer plans that are small add-on plans for a bit more coverage that unions negotiate for. it would take the pressure off both parties for getting basic coverage and leave any additional negotiating to cover what things a single-payer plan doesn't (or add on others). let the market decide how that works*

*uh oh.. a liberal who doesn't mind letting the market work now and then.  I hope I don't get my liberal card revoked :)

Anyway, don't know if all of that made sense. But a summary of that 80+page plan would be helpful if it can be provided. And translated from Wonk to English, please. ;)

<I>Is this how you do italics?</I>

I think that the best proposal for universal health insurance is that put forward by Ted Halstead and Michael Lind in their book, "The Radical Center."  Their proposal (summarized here and described more fully in their book) is for mandatory minimum personal insurance carried by each individual, supplemented by additional insurance provided as a perk or incentive by employers, unions, etc.

To ease the transition, would it be possible for the government to set up a competing system that employers could buy into initially as a choice, essentially allowing companies to buy into medicaid or medicare.  The centralized system, being intrinsically more competative (given the economies of scale and hopeful negotiating power) will be able to offer more and more attractive insurance packages to employers.  As the pool expandes, the question would then be, how far the "profit" coming from competetive plans be able to go in terms of subsidizing those who can't afford care (and raise the possibility of increasing the maximum salaries upon which medicaid kicks in)  Presumably, this would ultimately lead to the decline of insurance companies, but in a slower more controlled way.  This would also leave open the possibility for a two teired system, that while not rationing health care to the poor, would allow companies to woo employees with more generous private health care options, and perhaps keep some of the incentives for inovative therapy.

You have to let people with means provide for their own, superior medical care at their own expense, or forget about it.

That sounds fine to me. I haven't heard anyone suggest that this would not be possible. The Clinton Health Care Plan was a disaster for so many reasons, but mainly because it was far too complex and did not eliminate insurance companies.

Universal Health Care here in the US, but it isn't going to happen until the GM's and Microsofts of the business world find it to be in THEIR self interest.  Really, think about it.  Our elected people aren't going to suggest anything until they hear buisness talking it up.  They remember what the demogogues did to Bill & Hillary's attepts back in the 90's and want no part of that.  Even though most of what they said then has now come true.

 Individual citizens vote but the representatives are listening to business on this one.

 Find some Powerpoint presentation that shows 'em how much cheaper it is.  The they will jump on the bandwagon.

I know this approach sounds like exactly what is ailing the US right now,  guess what?  You're right!  It is.  Exactly.

Let’s face it, Americans are simply more individualistic and enamored with the idea of choice than citizens of other countries in the developed world.

I think this is far more true of political and economic elites like Mr. Anrig than it is true of the population at large. Most Americans don't mind big government as long as it works. They love their Medicare, for instance.

Political elites have got to stop projecting their own preferences on a population that doesn't necessarily share their views.

Setting political calculus entirely aside...

Hello, McFly...?

This line strikes me as a red flag.

You know what the red flag says? "Clueless"

Go back to whatever wonk institution you came from.

I participate in blogs to discuss the real world, not some "non-political" universe that exists in some wonks mind.

"Setting aside the politics" when discussing public policy is sorta like a Marxist, an Objectivist or a Christian saying, "if everybody followed my ideology we wouldn't have these problems."

It's true in a theoretical sense but completely worthless to those of us trying to craft something that really works. 

If you're going to force people to buy an insurance policy than the price of the policy must be regulated. Wouldn't be fair to force some one, by law, to buy a product without guaranteeing them a fair price.

I have a couple of things to add, though I can't guarantee how coherent they're going to be.




I agree that Democrats are really good at the policy discussions and 80-page white papers, but not so adept at 30-second sound bites.  But in order to not be full of hot air, they must be prepared for the questions after the sound-bite, with real answers and not rhetoric.  If not, then they're just Bushies with different language.  And places like this are great for working out those details so that the politicians and televised policy wonks can be more substansive when asked.  When not asked, btw, they should stick to one or two key phrases.




I also agree that the Party needs one coherent message (though not monolithic - they should be willing to hear differing views of such a complex issue), and that they should not pick it for ostensively (sp?) political reasons.  Don't pick single-payer just because it's the least complicated and seemingly easiest to sell.




One of my biggest problems with the whole concept of universal healthcare is that it will ultimately lead to an argument of what should be covered.  The New America plan linked in another comment is interesting and one of the better universal plans I've seen sketched out.  However even that would bring up the issue of how to define "basic".  What is meant by "basic" healthcare?  There are some things everyone will agree on: an annual check-up, one GYN visit for women and prostate cancer screening for men, well-child visits, pre-natal care.




But after that, it gets far more complicated.  What level do you cover for prescriptions?  What's a reasonable deductible?  What's a reasonable copay (if you're going to use copays)?  Given the increase in common recurring ailments like allergies, asthma and diabetes, is coverage of that considered "basic"?  If so, which treatments?




And all of that is before you get to catastrophic care (where any discussion would have to take on the incredibly unpleasant issue of diminishing returns) and the so-called social isues (abortion, right-to-die, medical marijuana, etc).


Also, while I agree with the point that mandating the basic care isn't likely to incentivise (sp?) employers to stop contributing to add-on plans, I do think it will leave you with the social equality problem of people who can't afford or aren't offered the add-on plans.




I know that all I've offered here are criticisms and questions, but to be honest, on healthcare, that's all I have right now.  I know it's a huge problem, probably the biggest one this country faces right now, but I don't what the best solutions are.




I also want to thank Greg for pointing out that one of the reasons that Medicare has such low administrative costs is that they don't actually handle a number of the normal administrative functions.

What are we going to do to people that don't buy insurance?

Are we going to incarcerate them?

Maybe send the sheriff and an auctioneer to the house to sell their personal effects? 

It's not like a car where I can leave it parked if I'm not paying my insurance.

Also, I don't see how the mandatory insurance does boo to contain costs.

Universal health care costs less and controls costs more effectively. 

Insurance companies, HMOs and the market system have been tried. They fail to contain costs.

I want health care to cost less.

Some of the extra cost in the U.S. system goes to research but much of it goes to profit, exhorbitant executive salaries, advertising and accounting that would be unnecessary in a universal health care system.

The point of reform is not just to give everybody health care, but to make the system work better.

BTW, having medical research priorities based on profit skews what kind of research gets done. The incentive is to look for expensive ways to treat problems since there is more possibility for mark-up on expensive products. How much resources goes into treating common ailments more effectively? 

Find some Powerpoint presentation that shows 'em how much cheaper it is.

 Sorta like this or maybe this?

I agree completely. Let me add two things:

 
• Medicare's fiscal intermediaries participate because it's a good business decision for them. Yes, a single payer plan might destroy Aetna's business model, but if they find a way to make a profit being a FI, someone else will too.
   
 
• It's funny, but when I read the heading "Public attitudes toward government" I assumed the text to follow would describe a strength of single payer. If it's done right, a single payer program would be another example of how government can work for people. Adding health care to Social Security as an example of the value of government is one of the smartest things we can do to deflate the power of the right wing in this country.

You make a number of really excellent points in your comments on this thread, but I could do without maybe half the snark factor.

Not trying to start a fight, I'm just saying.  You seem to really believe in single payer, so instead of verbally smacking anyone who hints at disagreeing, try to convince them of your view.

I'm honestly open to being convinced, but this comment here doesn't do anything for me.

Here's the Cliff's Notes version of Leif Haase's plan (it was stupid of me not to put this link in the original version -- sorry)

I think it needs to be said that nearly all of the “problems” you have listed, sir, are actually quite laughable.

Administrative disruptions.  Transition costs?  OH, THE HORRORS!

Getting good value for medical spending.  Since wealthy conservatives can probably be expected to want to underfund any government-sponsored health care service, we should just accept that it will inevitably occur, so therefore we shouldn’t even bother ourselves to try to improve the whole system.  WHY?

Effects on medical innovation.  This is probably the most specious argument of them all, provided to us by the monopolists who own and manage the pharmaceutical industry.  Do people really believe that medical researchers would not have any incentive to try to come up with new, breakthrough drugs and technologies even if they were on the government’s payroll and received all the money they needed to do their work, fame for their innovations, and special bonuses for individual achievement?  Perhaps the shareholders of pharmaceutical companies would not be able to make as much money off of the researchers as they used to, but how would this stifle the innovative drive of the actual innovators?
 
Public attitudes toward government.  Because the Republican Party has been successful in poisoning the attitudes of many Americans toward “The Government”, we should just concede that it is impossible to change those attitudes?  Why the hell even have an opposition party if you are afraid to express opposition that might upset your opponents?

Perhaps the strongest reservation that most Americans have about Socialized Medicine is the “waiting lists” that they’ve heard about.  The waiting lists exist when society chooses to ration relatively scarce health care services on a basis other than wealth.  When we rely on the pricing mechanism of markets to distribute scarce health services & technologies, then we are rationing according to wealth.
Many people find that approach to be morally abhorrent. After all, who should get a desperately needed kidney—a fifteen-year-old poor child who has a lot of promise, or an eighty-nine-year-old patient suffering from other serious conditions who happens to have a lot of money?

As Anrig has pointed out, excessive waiting times for [mostly elective] medical procedures is essentially a matter of underfunding.  If you increase funding, you are able to hire more doctors, build more operating rooms, and purchase more equipment.  That reduces waiting times.  The United Kingdom’s National Health Service would be able to dramatically reduce waiting times if they were to spend anywhere close to the amount of money that Americans spend on health care.
America’s private health care system costs Americans more than twice as much as the NHS costs the citizens of the UK. In 2002, UK citizens spent only about 8% of their GDP on health care ($2,160 per citizen). This compares to the approximately 15% of GDP that Americans spent on health care that year ($5,267 per citizen).  [Source: OECD]  In spite of the parsimony of the UK’s ruling class, the NHS has provided the British  people with health outcomes that are roughly equal to that Americans, who pay twice as much.  This empirical evidence tell us that Socialized Medicine in England is far, far more EFFICIENT than America’s private sector alternative.
The only problem with the NHS is that it has been chronically underfunded due to the pressure of conservative politicians, et al.  If there is one lesson we can learn from the United Kingdom’s experiment with Socialized Medicine, it’s that America could dramatically improve the health care of all of its citizens if it were to copy the UK model.  Spend the same amount of money, enjoy great improvements in economic efficiencies, and generate a dramatic reduction of wait times—in spite of a big increase in demand for elective services—by dramatically increasing the supply of doctors, equipment, etc.
For some additional perspective on the topic of government program underfunding, see Government Bureaucracy vs. Private Sector Efficiency at the www.taxwisdom.org website

Yes, universal health coverage would lead to arguments about what should be covered.  But hey!  I think that would be an improvement!  I have decent health insurance coverage, but absolutely no input about what is or is not covered-- we have the health insurance that my husband's employer chooses to provide.  Most Americans currently have little or no choice and no say about coverage.

Regarding the point that Medicare is administratively cheaper because it doesn't have to cover the "normal costs" of verifying coverage, etc., may I suggest that there is NOTHING NORMAL about those costs at all!  They are a complete and total waste of health care dollars.  I was with two doctor friends this weekend who agreed that they are asked often by patients about whether a certain procedure will be covered, and that they rarely know the answer.  Both the doctor's office and the insurance company waste resources verifying coverage.  Even worse waste are the dollars spent by insurance companies trying to weasle out of paying for treatment that is covered, but if they can get you to not file the appeal within the correct number of days, or use some other bureaucratic method, they can avoid paying.

The government would make the rules and pay for malpractice.

How long will it take Congress to figure out it can save money by streamlining the malpractice system? 

I agree wholeheartedly, I was not particularly in favor of Hillary's plan -- because of the complexity that it retained. And it is no doubt that the complexity was what killed it -- or,at least, that's the hammer they used. Though I did support it because I thought it would move the issue forward.

I mentioned to my boss at the time (one in a long string of healthcare crooks I've worked for) that I figured there would come a time when we would wish for "HillaryCare", because Hillary's plan preserved a fee for service option -- the easiest and most lucrative to deal with. It was clear, at the time, that fee for service was on the way out -- it is all but gone now and projecting hospital's revenue stream has become an increasingly byzantine process.

Under the right circumstances (a "bipartisan utopia" for starters), I believe a single payer system would be welcomed by the providers. The biggest problem with moving to a single payer system is that the private, for-profit insurance companies are themselves, of course, investor owned and those investors are BIG MONEY interests, not to mention pension funds, etc. If you suddenly shrink their revenue stream, bad things are going to happen to mutual funds, etc. It seems to me, now here I am very much out of my depth, that any workable plan for a single payer system would have to recognize pretty significant transitional costs in order to, for want of better term, buy out the investors of the insurance companies.

Excellent post.  I am for national health care, but I do not think single payer systems will work in this country.  Hell, they aren't working very well in Canada or France, and the barriers to entry they had are nowhere close to us.  The US, whether you accept this or not, still has a higher quality of health care than Canada, though our number of uninsured is disgraceful.  Not politically, but pragmatically, a voucher system will be easier to implement since it works with existing structures.  I understand that many a liberal hates the insurance industry, and for good reason.  The industry has had a significant number of cases documenting abuse in the system and refusal of genuine pay outs.  However, oversight would necessarily increase if the government was picking up the tab from these companies and they would have a much harder time refusing claims.  Something to think about, I understand that there are genuine disagreements, but it seems to me Canada is an example of why we need to rethink the orthodox model of universal coverage.  I think those of us on the left sometimes get too enamored with a specific version of a policy instead of just the policy.  Empirical evidence should be payed attention to in terms of implementation of a policy goal.  If you doubt what I say about Canada's system, simply look at any Canadian newspaper over the last 2-4 years and see what the stories about their health care system are like.  Hint:  They are not praiseworthy.

Given that so much of the money and effort to create innovations comes from publicly funded universities and tax payer subsidized grants already, bringing prices in line, as a single payer system would, just makes the system fair. As it is now, I get to pay for drug and treatment innovations and then I get gouged when I try to purchase them.

"And the medical malpractice gravy train would end for trial lawyers."

So why not call single payer healthcare "tort reform"?  Then the Republicans would like it, too!

[Sorry, I just couldn't help myself.]

Ah, but the GMs and the Microsofts are moving off-shore where they don't have to provide health care benefits.

Missing in this whole discussion is how to pay for this new system, what ever it is. A single payer system is easy to describe, the costs are readily apparent, and devising the tax schedule to pay for it is relatively simple. Did you all catch that? A new tax will be needed - we cannot expect employers to pay for our health care, because we are not all employed, and those who are, do not all work for the same employer or even in the same industry. So, before I jump on any band wagon here, I want someone to figure out what the tax I will be required to pay will be. If that tax is comparable to my existing health insurance premium I will be on board, but if it is twice as much I will look for a different train.

Is there a reason that subsidized health insurance won't suffer from the same market failures that characterize the current system - adverse selection leading to high premiums and suboptimal provision of insurance?

I'm not sure where the humble thing comes from, because I guess I didn't consider that in regards to either of you, but it's obviously something that bothers you, so to address part of what you're saying:

And I've checked a couple of Anrig's earlier threads. Apparently Mr. Anrig can't be bothered to engage in a dialogue with his audience.

Do you think it's respectful for bloggers to start a discussion but not respond to the comments made by the audience?

I think in general it's wonderful if "involved" people who blog get down and dirty into the comments.  But I also recognize that anyone with a job (myself included) doesn't always have time to read every response to a major comment-attracting post like this one.  Although I'm following the comments of this post closely, it's only because I happened to have time today.

I also leave open the possibility that Greg will respond en masse via another post in the same way that Anthony Romero did earlier today.

1. Much of the Dem leadership supported the Iraq War.

True, but so did much of the country at the time.  And please note that I'm not arguing the merits of that, just stating a fact.

2. The Dems haven't had the guts to say they are either going to raise taxes or cutting spending, but they do say they don't like deficits.

No offense, but well, duh.  I mean, when competing against people who actually believe in a free lunch on a grand scale, you're not going to get anywhere hollering that there's a price to be paid, whether it's true or not.  If the world were a better place, we'd be able to have an honest public discussion of this, but if this were a better world, George W. Bush wouldn't be President.

3. Clinton pushed through NAFTA and the WTO and again the Dems don't have much of a plan to mitigate the bad aspects of economic globalization.

I actually do think a number of Democrats have advocated for transition assistance, educational assistance, extended unemployment and a variety of other programs.  It's not a perfect solution, but globalization also wasn't going to be stopped by not signing those agreements.  The problem again is funding and those programs are, unfortunately, an easy and relatively hidden target of Republican "cost cutters".

4. Only a minority of elected Dems even think universal health care is worth fighting for.

This I can't speak to, except to say that after the hammering the Clintons took, I'm not exactly surprised that Democratic politicians aren't eager to get on this merry-go-round again.

Thank you, Anrig for finally challenging the emerging orthodoxy.  I am amazed, continually, by the people who when faced with basic, sensible questions about single payer - like how it would transition, who would pay for it, or how it can possibly work structurally - resort to the responses of the cornered. -"it just will"  -"people will like governement"  -"everything will be rosy when the insurance companies are gone."

I don't love insurance companies, health insurance, doctors and their organizations, or hospitals.  (I'm not so negative on pharmaceuticals, but I recognize them for the Marketing engines that they are.)  But I do understand that these groups have a huge stake in maintaining the status quo, that they, and their issues, cannot be wished away, or dealt with by some pie-in-the-sky notion of a world where you just eliminate a whole line of insurance business with the stroke of a pen.

There are some very real, very painful questions about how a single payer system would be structured that no one has completely honestly addressed.  There is no clear indication that all Democrats, never mind Republicans, actually back single payer.  There is no indication that the public is moved by the argumentds for single payer, or in fact understands in any realistic way, what the current issues in health care are.  And few, if any of us, really have a grasp on the whole shape, size and nature of the multiple health care delivery systems currently in place in the United States.  All of those things need careful consideration before any serious plan - a plan with any real chance of passing - can be considered.  America's history invoilves a combination public and private sector solutions, and single payer (so far) is out of balance with our historical approach.  That needs to be looked at, and answered.  Seriously and thoughtfully.

And all of that before we even discuss the extremely painful, and extremely frightening issue of just how bad the financial state of Medicare actually is.  Medicare for all?  I don't see how when Medicare is already headed for disaster.

weboy, the great unregistered

We are Democrats. We believe in paying for programs ourselves, and not just passing along the cost to our children and grand children. This is a major change to go to a single payer system, and it will, like Medicare, require that we all pay a specific tax to finance it. It is a solvable problem to figure out what that tax will be, so that needs to be done for any programs proposed. We can then compare that tax to our current medical insurance costs or to our current medical expenses and make a rational decision about the desirability of it. It would be a crime to pass such a system without this step. Just for reference, I currently spend between $300 and $400 a month for my medical care and insurance. If that were a tax, it would be in the neighborhood of 10% of my income - acceptable to me.

It sounds like you want to nationalize the pharmaudical companies as well as the health care delivery system.  Is that right?  How about medical equipment manufacturers who make CAT scanners, MRI machines, ultrasound ect.?

Sorry, the way to save costs is to get rid of employees, not protect their jobs.  If the insurance companies need to be run out of business to improve health care, then their employees will have to try to find other work.

I'm a bit flabergasted by your callousness, to be honest, but let me try to engage you substantively here.  Where, praytell, would you suggest these thousands upon thousands of people look for these new jobs?  These are accountants, customer service reps, salespeople, actuaries, secretaries, claims processors and on and on.

I'm not saying there isn't fat in the industry, but running them out of business, as you so casually encourage, means ALL the jobs would be gone.

Greg-
I know you are getting killed in the comments, but as an American who lives in the U.K. I do believe you have some very valid points. Single-payer appears to be a panacea for Americans longing to ensure all Americans can see a doctor and go to the hospital when they are sick.
It just ain't that easy. If we move to a single-payer system, health care becomes a political football rather than a personal choice. I watched in the last election as the Conservatives used "hospital cleanliness/Superbug" as an attack on Labour. It didn't work, but suddenly my local hospital became the focus of a line in the party's manifesto. How ridiculous is that? The Conservatives have standards and guiding principles. Imagine what Republicans could do on this issue.
Even if you could sell single-payer politically, please don't be fooled into thinking all health care delivery problems are solved.

As far as I know, any cost-saving measure is going to cost  jobs. This is the same old argument about featherbedding, efficiency,  protectionism, etc., that has been going on for decades.

I guess I'm sort of boggled to see it come up in this context, when one effect will be to deliver healthcare to more people cheaper.

I've always favored paying transition costs for displaced labor, though as far as I know that has almost never happened so far. I can't see keeping inefficient insurance companies afloat as a job-preservation measure.

Yes, I realize it's going to cost some jobs, but for one thing, the poster above showed absolutely no sympathy for the actual people and two, there is a vast difference between trimming the fat and reorganization (to better provide the add-on accounts people have mentioned, for instance) and driving the whole industry out of business.

The same place people who get laid off every day go.  If they have usable skills they will find better employment.

Listen, Democrats need tio decide whether they are serious about reforming the health system or if they just want to protect jobs no matter how productive they are.

Other countries emphasize wellness care, which is a huge (though not technicological) cost-saving innovation.
In China, for example, for a very low expenditure, millions are offered qi gong (the predecessor to tai chi), which builds health through gentle movement -- and hence lowers longterm health costs.
I think we over-value high-priced equipment and medications, when low-priced solutions might have far better outcomes for most of us.

I can only conclude that you work in the biz. In my lifetime I've seen whole industries ( farming, loggings, fishing, mom-n-pop retailing, and manufacturing) pinched severely by various sorts of economic changes. Ultimately  the answer has always been, "That's progress; they should go on with their lives".  And they've really had no choice but to do that.

I'm pro-labor and have have had mixed feelings about this kind of progress in the past, but it's a done deal. I don't think that things will, or should, change for Blue Cross employees. Some, but hopefully not all of them will be able to get jobs in the government health insurance area. Others will have to change fields, the way tens of millions of other workers have had to do over the last several decades.

I used to work in a hospital environment, and there are whole job classifications who do nothing but coding, mostly for insurance purposes. That won't all go away, but almost any system will be better than what we've got.

Yes, change will involve pain.

But it's not like the status quo avoids pain.

As for your argument that it's just too complicated. Tax policy is complicated too, but the GOP doesn't fret over reducing to "taxes bad, GOP hate taxes". You ever hear Republicans fret over, "terrorism complicated getting tough isn't the full picture"?

OK. So converting 13% of the economy from something that sucks to something better is gonna involve upheaval.

Oh well...

Gotta break some eggs to make an omelette. 

When I say minimize central control, I assume that doesn't mean NO central control. Obviously, he who pays the piper calls the tune. And, just as Medicare does now, the gov't payer would decide what to pay for and that would, of a necessity, impact on what types of equipment gets purchased. Inevitably, few providers would provide services that the gov't didn't cover. Few providers offer services now that insurers don't cover. There's not a whole lot of difference between what the typical insurer covers and what Medicare covers. What I would warn against is the gov't dictating to providers what they can or can't provide in terms of technology or services. Hospitals have a lot of experience tailoring their services to what their market needs and can, or will, afford.

There is effectively no free market in healthcare now. 90+ percent of patients come into hospitals and clinics with some kind of preset limits on what is going to be approved to be paid for and for how much. However, it is different for every patient. It's like having dozens and dozens of central planners all with slightly different ideas of what the plan is supposed to be. In a perfect world, the single payer would just reduce the current mess to a much simpler system where the providers have only one main payer to negotiate with, instead of a multitude -- and remove the threat that exposure to indigent care in ER represents since everyone would be covered.

I would advise you not to associate Dennis Kucinich with any policy you want to get through any forseable congress.

One proposal I have seen would be to use a VAT tax to fund the system. This would spread the burden across the whole economy rather than focusing it on business alone. VATs are very efficient revenue raisers and they are difficult targets for anti-tax demagogues since they are largely invisible, which is why the rightwing has always shouted down any suggestion of their use for anything in this country.
And remember: one of the biggest selling points of any sort of healthcare reform is that it should relieve employers of this burden, thereby enticing the corporations on board the bandwagon, and ending the current distortion of the labor market which even HIPAA failed to ameliorate fully.

Some are concerned that a single player plan will cause medical rationing and waiting lists.

Many say that this with result from under funding the program. However another cause for rationing and waiting is that there will not be enough doctors to give timely treatment. Say for a particular medical condition M, today there are people with M who cannot afford to be treated. Once universal care opens that will not be an issue and there will be increased demand on M treaters. There may not be enough of them and that will create a backlog.

Currently the AMA deliberately limits the number of doctors produced by medical schools in order to make their scarcity limit competition and drive up doctor earnings. High doctor earning also feeds back to raise the barriers of entry costs (e.g. the extremely high cost of medical school).

Here is an analysis of some data from the AAMC: med school matriculants have increased from 16,307 in 1993 to 16,648 in 2005 - a whopping 341 seats or 2%. That rate is much less than the population growth of the US over the same period so the medical students per population ratio has substantially declined and doctor scarcity has increased.

Some doctors say that schools can't admit more students because that would lower the quality of doctors and present a public danger. But if you look at the above chart you can see that over the 1993-2005 period the #matriculants was nearly constant, but the #matriculants/#applicants varies from 34.5% to 49%. Does that mean that smart people should avoid doctors who matriculated in 2002 (49%) because they are much more likely to be a danger to society?

The AMA is opposed to a single payer plan I don't know all the reasons. If such a plan comes to be the AMA may try to further increase doctor scarcity.

C'mon!

Your fourth point "Public attitudes toward government" is an attack on the political viability of single-payer. Eventually you work your way around to the peripheral idea that single-payer will make gov't less popular (which even if it was true isn't directly germaine anyway). But the bulk of the paragraph is devoted to an implicit swipe at single-payer's political viability.

So, I repeat. You create a set of assumptions for discussing your idea that exclude the political considerations that hurt your idea while including the political considerations that hurt the competing idea.

It's either dishonest or less-than-rigorous intellectually. 

I'm unemployed and depressed, as in recurrent clinical. I am completely without insurance (and therefore health care) because no insurance company will take me with my hideous prior condition which makes me less than worthy or human, I guess. All the rules about insurance apply only to insurance gotten through employment. When you buy your own, you're on your own. Given the way the need for the market to get it$ due drive$ every a$pect of policy in thi$ ¢ountry, I don't expect that to change any time soon. We've got to love, and care for, and protect those corporations, especially the insurance companies, right?
Perhaps it's better this way; my personal narrative is about being excluded instead of what I need being so costly that it's out of reach, which is what the case would be  if I didn't have this "prior condition." I'm pretty sure that if we don't get the simplest, most basic and universal system underway pretty soon, I will enroll in Medicare having been almost 15 years with no health care at all save the rare emergency, like the appendectomy I had two years ago. What followed was the most profoundly humiliating and (yes) depressing episode of my life. 
If the debate originates with a complex system with a lot of conditionals, what we get will not include people like me, who through little or no fault of their own have stepped off the employment merry-go-round and haven't found a way back on. Either it's the right thing to do to see that everyone is cared for or it's not, and what I hear some of you saying is that it's not.