The problem with a single payer program in real time is that it will still emphasize sick care. In the U.S., our coding system for diagnoses and procedures is all about sick care. I envision a single payer program as being focused on prevention, promotion, and primary care with the continuation of third party auditors to maintain vigilance on fraud, waste, and abuse practices. I envision increasing use of telephonic patient encounters and telehealth in a single payer system. I envision more meaningful partnerships between practitioners, clinicians, patients and their families to establish health education practices that would place more of the onus of health status on the patient and caregiver. Hopefully, emphasis on prevention, promotion, and primary care will hold the line on substantial increases in our taxes or outgo under a single payer system.
Right now, with emphasis on sickness care and extreme profit and consumers low level of health literacy and indifference toward their health status, healthcare is out of control. If single payer is done right, it may work.
However, I wonder if we just should not have a hybrid system whereby prevention, promotion, and primary care is sponsored by a single payer entity and the catastrophic is paid for by a combination of the patient and other entities. I feel that in the case of most chronic diseases and certain injuries, the patient should be on the hook when the condition perhaps could have been avoided. For instance, if my primary care provider advised me to avoid engaging in high risk activities such as overeating, eating unhealthy foods, avoiding exercise, or driving dangerously then there should be some liability on my part particularly if I demonstrate high risk activity under the primary care provider's watch for some time and it's documented in my record.