What is single payer health care?

How would the health care plans in Congress affect the legal ability of a state to enact single payer?

• I know about the issues with ERISA and Medicare, but about the issues with things like state-based (or national) exchanges, the requirement that states provide at least 2 national plans in their exchanges with at least one being private, non-profit (under the Senate bill), and the penalty for employers that don't provide benefits coverage, how would a state get around that to implement single payer care? I can see them perhaps implementing it with a state-based exchange, but that would mean offering only one product; under the national exchange though, and especially if there is a plan that opens up competition across state lines, it would seem to make it impossible for a state to implement a single payer plan on its own. If a state must provide at least 2 plans, with 1 private, non-profit plan, then how could it legally provide single payer on its own? If a state provide single payer health care, then its likely that employers in that state would not offer employee health plans of their own, since they would already be paying taxes for the single payer health care, but what if the employer mandate is enacted with penalties for employers that don't provide health plans to employees? Wouldn't a state single payer health care plan put such employers in a bind, in a way that could be considered to contradict preempting federal legislation? I'm looking forward to your answers regarding this question, but I'm not interested in reading about support or opposition of either the current health proposals or single payer in your answers here, so please keep that in mind.

• Answer:

  Any definitive answer would have to come from someone who takes the time to read and study the bill, and who has enough of a background in the area to recognize the consequences and implications of all the major provisions. One motivation that's most clear in the bill is the desire for congress to enable and encourage experimentation in the field, and for congress to review the results. If a state wanted to impose single-payer, and some provision in the bill prohibited it, then I'm confident the state would work with congress to make the necessary changes to allow it. The state would need to be willing for an influx from neighboring states wanting free healthcare. The most likely provision, if it's not there already, would be to eliminate any employer mandate in a state with a single-payer uniform system. That would make sense. The sense of congress might be that a single-payer system is not the best choice. If so, they would try to encourage states to try to find a better system. And I think that's what congress has done. But if a state really wanted to impose single-payer, I don't think congress would try to stand in the way. That's just my sense of the current political climate, and the kinds of discussions I've been hearing among thinking people. Congress couldn't help but see how well organizations like the Mayo Clinic work to provide top quality health care, costs well below average, comprehensive patient-centered care, teamwork, doctor and patient satisfaction, and incentives that no longer favor the more-tests-and-treatment is better approach. But they can't wave a magic wand and flash that structure into existence. So they tried to structure incentives and encourage experiments and actually looking at the results of those experiments, and let natural human and market forces work toward a better system. They've tried to remove any legal impediments, particularly in the area of insurance regulation reform. But I'm sure that, as usual, insurance industry pressure helped temper those reforms. PS: It's refreshing to see a good, thoughtful question on the subject!