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All of your points except the first one seem more relevant to the debate between single payer vs. multi payer. But I'm specifically asking, assuming single paye

All of your points except the first one seem more relevant to the debate between single payer vs. multi payer. But I'm specifically asking, assuming single payer (ie. without a loophole that makes it multi payer), why is it necessary to proactively outlaw other plans rather than let them die? I think your first point kind of gets at the crux of it though: you want providers to only have to support a single payer in order to reap the administrative efficiencies, so you either need to make a law that says that providers must only accept payments from the single national plan, or that insurers can't offer plans that pay separately. Those two options seem equivalent to me, but the first one (forcing providers to only accept payments from the national plan) seems more intuitive than the second to me.

cosmie 8y ago
For sure, the first point is pretty critical to ensure market viability of a single payer system. The potential reductions in administrative overhead absorbs some of the expected reductions in reimbursement amounts that'd come with a single payer system. But even if you can make it work out from an economics standpoint, it can ultimately fail from a political standpoint if people feel like it's a failure. And there are a lot of entrenched interests that would benefit from a failed single payer experiment. My other points were geared towards that component. Letting the multi-payer environment die out organically leaves a grey area with potential consumer confusion and frustration during the transition period, and also leaves the infrastructure in place to easily roll back the single payer plan if you adequately exploit that frustration. Forcefully cutting over to a single payer system allows a clean break so both the consumer and provider side of the market has the opportunity to validate if the claims in the single vs. multi payer debate can be realized, without creating a giant attack surface for political and market shenanigans that could kill it before it really got going. It also raises the level of effort required to roll back the single payer system, since the infrastructure and and staffing to support it is reduced more rapidly than if taking a "let them die on their own" stance.

cosmie 8y ago

For sure, the first point is pretty critical to ensure market viability of a single payer system. The potential reductions in administrative overhead absorbs some of the expected reductions in reimbursement amounts that'd come with a single payer system. But even if you can make it work out from an economics standpoint, it can ultimately fail from a political standpoint if people feel like it's a failure. And there are a lot of entrenched interests that would benefit from a failed single payer experiment. My other points were geared towards that component. Letting the multi-payer environment die out organically leaves a grey area with potential consumer confusion and frustration during the transition period, and also leaves the infrastructure in place to easily roll back the single payer plan if you adequately exploit that frustration. Forcefully cutting over to a single payer system allows a clean break so both the consumer and provider side of the market has the opportunity to validate if the claims in the single vs. multi payer debate can be realized, without creating a giant attack surface for political and market shenanigans that could kill it before it really got going. It also raises the level of effort required to roll back the single payer system, since the infrastructure and and staffing to support it is reduced more rapidly than if taking a "let them die on their own" stance.