patrick.net

Yep, single payer is the only way to go. It's not the only thing that needs to be done, but it is the first thing that needs to be done.

Call it Crazy says

Yeah right, because Government run (Medicare and Medicaid) health care has worked out so wonderfully and are so cost effective.....

Whether or not government is incompetent is irrelevant. Some things cannot be handled by the so-called free market. The roads and the military are two such examples. Health care billing is another.

Furthermore, single payer does not have to be implemented by the government. I'll gladly implement and run the whole damn thing myself. Give me a mere billion in start-up funds (probably much less) and the right to 0.01% transaction fees on all bills and I'll rake in billions of dollars a year in profits. It will be the easiest job of my life. The whole damn thing will be automated, running on a private cloud. I can have the whole system up and running in a year.

I dare any politician with the power to make this happen to call my hand.

What if the doctors don't like the payment rates that single payer offers? Roads don't have kids or spouses or grandparents to feed. Military doesn't need 12 years of higher education to train. What will you do when your doctors quit to become software engineers and tell you to have a nice day with your cancer?

A single payer system was initially what Obama tried to push forward but of course the GOP wailed and complained about anything remotely close to something that resembled a more universal healthcare plan. So basically something getting done is better than nothing. I expect that in the future more changes will be made to the law to make it more effective and perhaps closer to being a single payer system because long term that's the only way its likely going to work.

Zak says

What if the doctors don't like the payment rates that single payer offers?

Single payer does not set rates. It records and publishes them. The mechanism for setting rates is an independent concern. It could be done by a central authority, the free market, or any other mechanism.

Zak says

Military doesn't need 12 years of higher education to train. What will you do when your doctors quit to become software engineers and tell you to have a nice day with your cancer?

Doctors do not enter the billing information. Small practices have secretaries to handle that. Hospitals and large clinics have a billing department for doing that.

In any case, keeping billing information up-to-date is something that needs to be done anyway. Single payer streamlines this administration requiring only a single system for all billing concerns instead of the thousands in existence today. This simplifies training and reduces administrative costs.

If implemented correctly, single payer also adds better accounting for the health care industry and can provide the public with useful statistical reports on the costs of services allowing for better health care planning on both the individual level and for society as a whole.

Call it Crazy says

BINGO... That's happening RIGHT NOW with Medicare.....

BINGO... That's why the opinions of people who bitch about single payer are worthless. Those opinions are based on complete misunderstanding of what single payer is and what it does.

It's like people who object to vaccines because they think vaccines inject demons into your bloodstream so that Satan can possess your body. When a person's opinions are based on such far-fetch and inaccurate nonsense, there's no reason to listen to those people.

Call it Crazy says

OR, they take CASH only for services???

Revoke their license. The fear of this would keep any doctor or health care provider from even considering doing this.

First, there is no disadvantage to doctors using single payer as single payer does not set rates! Both my sister and her husband are doctors, I hardly would want to screw doctors out of their income. I firmly believe that people who save lives with their hands should be well paid. It's not like they are doing worthless tasks like the financial industry.

Second, single payer reduces costs to doctors by making billing essentially free. Almost all the costs of billing goes away, as well as the risk of non-payment. Doctors are free from even having to worry about getting paid. For doctors, single payer is the best damn thing since slice bread.

I happen to like my kaiser insurance. You can take your single payer idea and shove it commie.

How do we know this?
You may hate your sister for marrying the brother-in-law you despise, enough to fuck them out of every last penny to both their names.

Dan8267 says

Both my sister and her husband are doctors, I hardly would want to screw doctors out of their income.

We have obama and nancy pelosi to thank for not getting single payer and instead being stuck with this neo-corpora-fascist crap that we have now. Those two greedy sons a bitches just couldn't turn down the bribes from the evil insurance companies.

Well, they were evil and everyone hated them, and all they did was fleece us,,,,until ppaca got dubbed obamacare and it became his signature legislation. At that point, every mindless demtard became defender of those evil corporations. Solely because obama and pelosi told them to.

Dan8267 says

Single payer does not set rates. It records and publishes them

Ok lets break this down : single payer - the one place that pays. So either: a) the doctor sets the rate, you go, and it is 100% covered at whatever rate the doctor sets. b) the payment is partially made based on some "centralized authority" schedule of what the payment should be. c) Payment/provider is denied/not authorized as "too expensive"

Case a) seems like doctors/providers would just charge as much as they want, system would quickly melt down. unlikely implementation.

case b/c) more likely. doctors switch to cash pay or drop out as central government tries to make health care affordable on their backs. Everyone struggles to make it work, but it eventually starts going bankrupt like NHS of England is doing. Road to hell paved with best intentions is seen after generations of failure. Rich pay cash and are fine as always... Poor suffer as always...

Dan8267 says

Call it Crazy says

OR, they take CASH only for services???

Revoke their license. The fear of this would keep any doctor or health care provider from even considering doing this.

Right, no freedom for you doctor. This is why you think you are better. You think you know better than the doctor. Go run your own life and learn what it really means to be in charge of something before you try to take over with your armchair hypocrisy.

drudometkin says

I happen to like my kaiser insurance. You can take your single payer idea and shove it commie.

The function of single payer and the function of insurance are completely independent. Furthermore, single payer is no more communism than Visa or Mastercard.

Whether or not health insurance continues to exist is an issue entirely independent of single payer. Single payer is not an form of insurance. It is a centralized clearinghouse and accounting system for health care billing.

SoftShell says

How do we know this?

You may hate your sister for marrying the brother-in-law you despise, enough to fuck them out of every last penny to both their names.

More evidence that the opinions of conservatives are based on delusions, fantasies, and myths.

Zak says

Ok lets break this down : single payer - the one place that pays. So either: a) the doctor sets the rate, you go, and it is 100% covered at whatever rate the doctor sets. b) the payment is partially made based on some "centralized authority" schedule of what the payment should be. c) Payment/provider is denied/not authorized as "too expensive"

Single payer is not insurance. It does not "pay" your bill. You and/or your insurance does that. Single payer handles the accounting. It's a freaking menu for medical services just like you have a menu at restaurants. Don't blame the menu for setting the prices; the restaurant does that. The menu lets you know the prices and shop around before you order. So does single payer.

It's amazing how "free-market advocates" seem to hate the idea of apply a free-market to health care.

The health care provider sets the price. He had better set it right or his customers will go to some other provider since the prices are now public and thus competition drives fair market pricing -- something that does not exist in the current system since you don't even know what the prices are until you receive the bill.

Once again, you're complaints have absolutely nothing to do with single payer. It's like talking to a person who keeps complaining that his bananas don't get good gas mileage. It does not apply!
If insurance is used, the same business happens as it does now between you and your insurance company. No better, no worse.

If you are afraid of free-loaders, then you have to nationalize health insurance. But that's an independent issue. Single payer works for what it does under both an insurance-based system and a nationalized system. The entire issue of nationalizing health care is absolutely independent of the issue of using a single-payer system. Health care can just as easily be nationalized without single payer; it just would be less cost efficient because of administrative expenses due to supporting thousands of existing billing systems.

Zak says

Dan8267 says

Call it Crazy says

OR, they take CASH only for services???

Revoke their license. The fear of this would keep any doctor or health care provider from even considering doing this.

Right, no freedom for you doctor. This is why you think you are better. You think you know better than the doctor. Go run your own life and learn what it really means to be in charge of something before you try to take over with your armchair hypocrisy.

Bullshit Straw Man argument. Today, doctors have to spend a lot of time ensuring that they are complying with a plethora of laws. Single payer reduces the number of laws doctors have to comply with.

Furthermore, there is absolutely no material difference between accepting dollar bills as payment or accepting the exact same amount of money through a direct deposit into a banking account other than the later is far more convenient. To argue that doctors are losing "freedom" due to having their bills go through single payer is either completely disingenuous or delusional.

errc says

Well, they were evil and everyone hated them, and all they did was fleece us,,,,until ppaca got dubbed obamacare and it became his signature legislation. At that point, every mindless demtard became defender of those evil corporations. Solely because obama and pelosi told them to.

Not sure how much weight in the debate I would take with such statements when the source mentioning them has a "healthcare plan" that relies on "Not getting sick"...

Call it Crazy says

Dan8267 says

Single payer does not set rates. It records and publishes them. The mechanism for setting rates is an independent concern. It could be done by a central authority, the free market, or any other mechanism.

You should really do some research and understand Medicare because right now, you're clueless about single payer and how it functions....

No, you're completely clueless about single payer and Medicare being entirely different things.

Single payer is a centralized clearinghouse and publication center for health care services and their prices.

Medicare is the federal government program that gives you health care coverage (health insurance) if you are 65 or older or under 65 and have a disability, no matter your income. When you pay taxes on your income, part of the money goes toward Medicare.

Single payer is not health insurance. Medicare is.

Single payer does not take tax dollars. Medicare does.

Single payer creates a marketplace for healthcare services where prices are known and people can shop around. Medicare does not. You only find out the prices of services after you receive them whether you are paying through Medicare, insurance, or out of your own pocket.

Single payer does not perform the same functions as Medicare. Implementing single payer won't make Medicare go away. Only nationalizing the health care system will do that.

Single payer is Medicare in the same way that Madonna is British.

Once again, you have demonstrated definitively that people who object to single payer have no clue as to what single payer is or does.

Dan8267 says

Single payer is not health insurance. Medicare is.

Single payer does not take tax dollars. Medicare does.

Why would you want to add another layer of administrative BS in the whole process? Right now, we have providers and insurance companies. Now you want to add a gov't payer on top of all that?

The best way to go is to have competing, non-profit HMOs like Sutter Health and Kaiser Permanente. HMOs are actually more like single payer systems elsewhere than people think, but without the monopolistic tendencies if we keep it competitive. Even the UK's NHS has been trying to learn more about how Kaiser does things.

Kaiser is non-profit and has no fee-for-service model. All of the insurance, billing, payments and claims are handled by the same organization, so, for the most part, you don't have to deal with claims from multiple providers. Because everyone is salaried, they try to give you the best outcome at the cheapest price. And, because you have competing HMOs, it keeps the competition fierce in each region such that HMOs have motivation to be cheaper, more efficient, more effective, etc. If we went this route and mandated everyone to get an HMO or some other catastrophic insurance like what ACA prescribes, we would cut a ton of cost out of the system.

debyne says

Dan8267 says

Single payer is not health insurance. Medicare is.

Single payer does not take tax dollars. Medicare does.

Why would you want to add another layer of administrative BS in the whole process? Right now, we have providers and insurance companies. Now you want to add a gov't layer on top of all that?

Why add a government layer? Because -- as shown by every other industrialized nation -- it seems to work.

It would be great if we had a system as cost efficient and universally covering as Singapore -- where 80% of the hospital beds are owned and operated by the government, and the bulk of healthcare money goes through government hands before it is payed out to providers public or private. Like Singapore has done, we would first have to shrink private providers to the roles that they seem to be good at and let the government take over a majority of hospitals. We would also have -- once again like is done by, very successful, Singapore -- to setup multiple levels of government savings and payment programs that are mandatory before one can be eligible to buy private insurance.

Also, the government layer is necessary to regulate/manage the healthcare market and assure that the private firms are playing by the rules.

You are full of bavarian bullshit.
Everything you state about single payer is incorrect.

http://en.wikipedia.org/wiki/Single-payer_health_care

Dan8267 says

Single payer is a centralized clearinghouse and publication center for health care services and their prices

leo707 says

Why add a government layer? Because -- as shown by every other industrialized nation -- it seems to work.

But other countries' single payer setups are different than what you're proposing. They don't have insurance companies and they collect the revenue, pay out the claims, etc., and proposing that type of model would be astronomical change. Besides, I don't even believe it's the best way to go...see my post above about competing HMOs.

Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs.

Dan8267 says

Zak says

Ok lets break this down : single payer - the one place that pays. So either: a) the doctor sets the rate, you go, and it is 100% covered at whatever rate the doctor sets. b) the payment is partially made based on some "centralized authority" schedule of what the payment should be. c) Payment/provider is denied/not authorized as "too expensive"

Single payer is not insurance. It does not "pay" your bill.

SoftShell says

Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs.

Dan8267 says

Zak says

Ok lets break this down : single payer - the one place that pays. So either: a) the doctor sets the rate, you go, and it is 100% covered at whatever rate the doctor sets. b) the payment is partially made based on some "centralized authority" schedule of what the payment should be. c) Payment/provider is denied/not authorized as "too expensive"

Single payer is not insurance. It does not "pay" your bill.

Yea, I think they want just a gov't entity that does the billing processing or something, but single payer in Europe is so much more than that. I don't think adding gov't in at a layer where they just act as a clearinghouse would add any value and just make things more complicated. If you're going single payer, you need to do what wikipedia describes if you want to think of getting any benefit out of it in my opinion.

But as I've said before, other countries with single payer lose out on competitive forces that drive efficiency into the system. Competing HMOs would deliver all of this and we wouldn't have to change around our entire system to do it since we have HMOs in existence already.

Zak says

doctors switch to cash pay or drop out as central government tries to make
health care affordable on their backs

But the problem is exaclty the opposite - the doctors in america are getting rich on the backs of their patients!!!

Average american general practitioner makes almost $160,000 per year. Comparatively, Switzerland and Netherlands are under $120K, France about 95K, Finland about 70K, etc. American doctors are compensated the most by far and you think this is ok? This b.s. sets up a vicious cycle where med school costs an arm and a leg because the doctors know that they will make "return" on this astronomical "investment." Guess who pays for it all? - the so called "customer" held up at gunpoint via your money or your life dillemma and that same sucka further beats him/her self by not taking care of their health the best they can.

debyne says

leo707 says

Why add a government layer? Because -- as shown by every other industrialized nation -- it seems to work.

But other countries' single payer setups are different than what you're proposing. They don't have insurance companies and they collect the revenue, pay out the claims, etc., and proposing that type of model would be astronomical change.

Right, -- well, sort of* -- and these other single payer systems do it all much cheaper, by at least half, than we do with our massive private insurance system.

* This was "sort of" because the examples I used were Singapore which does have a layer of private insurance. However, Singapore's private insurance is primarily utilized by only the wealthy and can only be used once one is fully vested in the government plans. A majority of Singapore's system is based on a single payer, and they have one of the most effective -- both in cost and results -- healthcare systems in the world.

There is no healthcare system in the industrialized world similar to what you propose. It seems that one of the best and most cost effective systems is to be like Singapore; having a strong government role in: regulation, long-term care, chronic conditions, etc; having everyone required to pay into the government system before they can buy private insurance; having private "free-market" competition do what it does best in healthcare: critical care, checkups, preventative care, elective procedures, etc.

leo707 says

There is no healthcare system in the industrialized world similar to what you propose. It seems that one of the best and most cost effective systems is to be like Singapore; having a strong government role in: regulation, long-term care, chronic conditions, etc; having everyone required to pay into the government system before they can buy private insurance; having private "free-market" competition do what it does best in healthcare: critical care, checkups, preventative care, elective procedures, etc.

I don't disagree if we could magically transform our entire healthcare industry in the blink of an eye to try it out, but moving to that model would be politically unpopular and very painful in my opinion...who knows, maybe I'm wrong.

However, I think we could get as good or better than Singapore if we morphed our existing model into competing HMOs. It's more likely given the political landscape, but my assumption is based on the fact that both nations would have equally healthy populations. Conditions caused by obesity in our country are so prevalent, and it costs our healthcare system more than most other chronic conditions...no healthcare system can fix that, it's individual choice and education.

You want to know why?

http://www.justice.org/resources/Medical_Negligence_-_Insurer_Profits.pdf

dublin hillz says

Average american general practitioner makes almost $160,000 per year. Comparatively, Switzerland and Netherlands are under $120K, France about 95K, Finland about 70K, etc. American doctors are compensated the most by far and you think this is ok?

SoftShell says

You want to know why?

http://www.justice.org/resources/Medical_Negligence_-_Insurer_Profits.pdf

dublin hillz says

Average american general practitioner makes almost $160,000 per year. Comparatively, Switzerland and Netherlands are under $120K, France about 95K, Finland about 70K, etc. American doctors are compensated the most by far and you think this is ok?

There's definitely that...I agree that the malpractice situation needs to be fixed.

I also think medical school is a complete racket with how much it costs, and they only allow in a very small number of elite. This often causes a shortage of doctors, which makes all the more advantageous for them to charge fee for service and make a ton of money. There's a lot going on as to why doctors are paid so much, and much of it is driven by themselves to protect their high salaries and elite status.

debyne says

I don't disagree if we could magically transform our entire healthcare industry in the blink of an eye to try it out, but moving to that model would be politically unpopular and very painful in my opinion...who knows, maybe I'm wrong.

Politically unpopular, very painful...I think you are right. We can dream though right ;)

debyne says

However, I think we could get as good or better than Singapore if we morphed our existing model into competing HMOs.

I had Kaiser for many years and did "enjoy" it, there are a lot of great things about it, but today its system would not be ideal to fit my needs. I think that the HMOs can be good examples of what private firms do well with healthcare, but they still have some pretty big deficiencies and depending on ones needs/condition the choices are very limited. Also, competing HMOs is still going to give the consumer a very limited "free market" experience; one still gets "locked in" to an HMO for a term (year?) and if they need a procedure they are stuck with in-house pricing and cannot "shop around."

I don't think that we would get very close to the efficiency in Singapore, because they have seemed to have struck a balance of when it is more efficient for the government to step in and take over care. A lot of that care, which is a lot of the heavy lifting in a healthcare system, is not run efficiently under the HMO system.

Also, now that I am thinking of it, HMOs are an option in our current system. If they could really provide healthcare at ~%25 of the current US cost (as does Singapore) one would think that they would be doing so, and US consumers would be flocking to them. At my current work HMOs are an option, but they are not priced any better. What is stopping them from becoming more efficient and competing the other options out of business?

leo707 says

What is stopping them from becoming more efficient and competing the other options out of business?

It's a great question. More membership! HMOs can run more efficiently when they get the economies of scale for the labor supply and assets that they have, which would drive the cost per member down. I'm really hoping that the mandate will force this and we'll see more people flood into our HMOs. I'm shocked that the HMOs you have access to are not cheaper, so I cant respond to that without knowing more. I do know that HMOs are usually 10% cheaper on average, but a large part of what's holding their potential back is the fact that most of America gets their insurance through their employer, so the options are limited thereby limiting competition. If individuals procured their own health insurance, HMOs would be driven to be even more efficient and competitive in a marketplace and you'd likely see more expensive PPO-type options diminish...but who knows til we try.

Also, because there are so many people using emergency rooms who are uninsured, those who are insured end up bearing the brunt of the cost, which is another reason why it's not cheaper than it is and I'm hoping the mandate will help a lot with that.

Additionally, here in the US we have the most healthcare-related technological advances in drugs, medical devices and treatment options than any other country in the world. We use all that technology far more than other countries to treat ourselves, and it costs a TON of money. In fact, I think using the latest advances is one of the primary factors as to why our healthcare is more expensive than other countries...and this includes HMOs using those advances too.

As far as your complaints about it as a system, it's unfortunately the cost we pay in having a narrow network and controlling costs. Single payer systems have similar issues and there's actually more rationing in single payer systems, which is a major drawback. However, HMOs do refer out of network for specialists when they're needed. One thing that seems to be impossible to obtain is access to a wide network at a cheaper price...I'm not sure there's any way around that but at least people will always likely have a PPO-type option if they're willing to pay for it.

Dan8267 says

Single payer is a centralized clearinghouse and publication center for health care services and their prices.

Dan, sorry, you are misinformed. From wikipedia:

Single-payer health care is a system in which the government, rather than private insurers, pays for all health care costs.

http://en.wikipedia.org/wiki/Single-payer_health_care

Maybe this is why you don't understand what people are railing against. If you think your definition is correct, you should definitely work to change what is up on wikipedia because just about the whole country agrees on that definition of single payer health care, with you as the exception.

dublin hillz says

But the problem is exaclty the opposite - the doctors in america are getting rich on the backs of their patients!!!

First off, $160k/ yr is HARDLY rich. Probably in the top 5% of incomes, but nowhere near "rich". Add to that, 160k is the AVERAGE. That means for every 800k/yr cardiac surgeon, there are 5 or 6 80k/yr family practice GPs schlepping away.

Second, if there is one set of people in this country who I could choose to be rich, the #1 occupation would be doctors. #2 would probably be inventors. The point is, the federal reserve is not sending 85 billion per month to our healthcare system, let alone doctors, they are sending it to banks. Screw banks.. seriously.. fuck them...

As for the rest of your diatribe.... seriously... you are laying our country's healthcare problems at the feet of doctors? Just fuck off. You are an idiot. These are people who work basically without a life and little pay through 4 years of med school, then 4 or more years of residency AFTER 4 years of undergrad college, with all the associated cost. Not one of these government plans has given one shit about taking a bit of the burden of med students and residents, or their associated loans, and your nose is all up in the ass of these politicians talking bout the smell of roses , and they just want to ream your butthole while you smile and tell em what a great job they are doing. Seriously... get fucked...

APOCALYPSEFUCK is Comptroller says

Freedom has its costs and one of them is having every last dime vacuumed from you and yours by a bunch of guys in lab coats standing over you shouting,

So you'll pay 6% on your 500k house to a realtor, but 30k is too much to cure your cancer? Yeah what assholes those guys are dedicating the first 30 years of their life to school and 100 hr weeks in hospitals for training. Jerks.. let em rot... Put liberals and neocons in office so we can siphon jobs to china, and talk about socialism and redistribution to keep it fair while we compete against slave labor... much more sensible.

Dan8267 says

If implemented correctly, single payer also adds better accounting for the
health care industry and can provide the public with useful statistical reports
on the costs of services allowing for better health care planning on both the
individual level and for society as a whole.

He he, and the med accounting/records software has made a female Bill Gates/recluse with a compound with 2 castles and an underground theatre that seats 15000 people in Wisconsin, that is almost cultish in the on-site training too.

She just might have a problem with that, and with you too.

debyne says

Dan8267 says

Single payer is not health insurance. Medicare is.

Single payer does not take tax dollars. Medicare does.

Why would you want to add another layer of administrative BS in the whole process? Right now, we have providers and insurance companies. Now you want to add a gov't payer on top of all that?

Single payer removes administrative layers by replacing thousands of billing systems with one centralize one. And you if you don't want the government doing it, petition the government to have me do it. I'll take no salary and a mere 0.01% of the transactions.

As I said, easiest job of my life. After a few years, I'll be sitting back doing hookers and coke and still raking in hundreds of millions a year as my fully automated single payer handles everything beautifully.

debyne says

The best way to go is to have competing, non-profit HMOs like Sutter Health and Kaiser Permanente

If you want competition, you have to have single payer. The current system does not have any kind of market at all, nonetheless a free market. With single payer, health care providers actually have to compete with one another. Under the current system (pre or post Obamacare, they don't).

Call it Crazy says

Dan8267 says

Once again, you have demonstrated definitively that people who object to single payer have no clue as to what single payer is or does.

Hmmm, I think it is you, Dan, who is clueless what single payer is....

Try taking a look at this link:

http://en.wikipedia.org/wiki/Single-payer_health_care

...."Medicare in the United States is a single-payer healthcare system, but is restricted to only senior citizens over the age of 65, people under 65 who have specific disabilities, and anyone with End-Stage Renal Disease.

Once again, you have proven that only idiots quote Wikipedia.

Medicare is not a single payer system. With Medicare, you still have to sign up for insurance and that insurance pays your medical bills, part of the bills, or fucks you over with the entire bill.

Instead of looking at Wikipedia like every other moron on this planet, realize that Wikipedia is edited by every slack jaw idiot, every asswipe with a political agenda, and every corporation trying to spin things. Once you realize this, start looking are real sources for information.

Straight from the fucking Medicare website (wow that was hard to find),

If you have Medicare and other health insurance or coverage, each type of coverage is called a "payer." When there's more than one payer, " coordination of benefits " rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" to pay. In some cases, there may also be a third payer.
What it means to pay primary/secondary

The insurance that pays first (primary payer) pays up to the limits of its coverage.
The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover.
The secondary payer (which may be Medicare) may not pay all the uncovered costs.
If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.

The phrase, "When there's more than one payer", should be your first clue that Medicare isn't a single payer system.

The whole fucking purpose of Medicare has nothing, nothing whatsofuckingever, to do with the purpose of single payer. How much clearer can I make it to you numbskulls?

If you think "single payer" means expanding Medicare to everyone, you are a fucking retard. Plain and simple.

Dan8267 says

Single payer removes administrative layers by replacing thousands of billing systems with one centralize one. And you if you don't want the government doing it, petition the government to have me do it. I'll take no salary and a mere 0.01% of the transactions.

As I said, easiest job of my life. After a few years, I'll be sitting back doing hookers and coke and still raking in hundreds of millions a year as my fully automated single payer handles everything beautifully.

You answered for yourself why single-payer system is a bad idea: the contractor (and everyone else put in that position) would just want more hookers and blows while putting in the least amount of work. Competition is what makes people put in work in order to earn their way to hookers and blows. It is this work from someone else that we all need in order to keep living.