JG comments on Wonks Anonymous skepticism on single payer:

Single Payer is attractive to liberals (aside from actually providing truly universal health care) because there is a huge chunk of money wasted in administration that dwarfs all of the cost savings in currently proposed health care reform legislation. While this may not solve the problems in the health care market and long term cost growth would probably still be unsustainable, in the short and medium term administrative costs are one of the biggest easily visible targets.

Beyond administrative costs, single payer makes other reforms easier. U.S.prices for drugs and medical procedures tend to be much greater than prices in the rest of the developed world. With single payer, price controls are more likely to occur than without it (see Medicare which"underpays" doctors).

Once the market is under greater government control, this also helps to transition toward a better payment model. Ontario has had success with Family Health Teams [1],which may be similar to the Accountable Care Organizations that you have been advocating.

[1] http://healthcarereform.nejm.org/?p=2612

Which is a great comment and Wonks Anonymous wishes he saw more such. Wonks Anonymous is in agreement with almost all of it except the price controls part.

It seems here that we have and need price controls on medical procedures because we are paying for medical procedures when we should be paying for integrated health care. Wonks Anonymous does not think that the ability to impose more draconian price controls is a good argument for single payer.

That said, single payer could make the transition to Accountable Care Organizations much easier. Our ideal Accountable Care Organization should sell integrated comprehensive medical care for a single periodic payment. Some large organizations - Kaiser Permanente for example - have managed to do this. They have survived in the health insurance marketplace by developing extensive marketing and insurance functions. They have also survived by becoming large enough to absorb risk.

Along the way these organizations have made compromises to cater to the concerns of employers and to compete with cheap but inferior products offered by other health insurers.

Single payer would make the Government the financial intermediary between the consumer and the health care provider. This could relieve the Accountable Care Organization of some of the load of risk bearing and insurance services.

If properly set up, Singe Payer would allow the consumer to enter into a relationship with an Accountable Care Organization just as Medicare recipients can now choose an HMO plan. Competition for the business of individual consumers would provide much better incentives for quality than competition for the business of employers who tend to be a bit less concerned about the quality of services.

Wonks Anonymous does not really see pure health insurance companies doing a whole lot of good in the development of Accountable Care. Their current business model - high deductible, limited coverage, high out of pocket plans - is based on making sick people pay for medical care according to the seriousness of their illness.

The proliferation of services and the complex pricing of fees attached to these services, while it really has no rational basis, does provide a mechanism that distributes the burden of the cost of health care most heavily to those who are ill. This enables insurance companies to continue to pretend to provide inexpensive health insurance services to employers and healthy individuals.

We might expect insurers to come up with gains sharing and other schemes that almost but not entirely unlike Accountable Care. Wonks Anonymous fears that only the government has the position to take the long view and promote real Accountable Care.

This is why Wonks Anonymous mourns the passing of the public option.