Single payer healthcare system discussion

I'll agree and talk with the next guy about government inefficiency and bloat, but in my time working private EMS It's FAR worse. Government has standards- in Private EMS we had an ambulance that lacked a floor under the peddles. Heck, I've worked for 2 companies that simply didn't have the money for medications and we had to get a waiver to push expired drugs on patients.

Also, the whole "Access to care is better in America!" is a joke. EMS has critical staffing shortages the nation over, and no matter who you are you HAVE to make appointments. Besides, hospitals are legally required to give you care if you're in an ER and need it- it's a full law.

In Reply to Robbie:

It's the same as having pizza with your mates. Everyone pony's up a couple of bucks for a cheap medium 8-slice one night when you're drinking beers on the back porch. You've eaten well that day and it's your house- so you only have 1 slice since you filled up on beer. One friend takes 3, another 4. This sounds unfair at first- but there's always gonna be pizza in the future, they've done the same thing for you in the past and you still have a kitchen full of options.

That's the basic reason it works. It's tax-based so everyone's always paying, and "fairness" doesn't really matter because you'll always have someone whom either A) NEEDS more, B) can work the system or C) It'll come around for you eventually. The B part a lot of people have problems with, but don't realize that they're throwing out an orchard because of one apple and that those things happen all the time in the current system anyway.

In reply to FuzzWuzzy :

Then that's an issue that needs to be fixed.  It's not an argument against the concept of a single payer system that works better, for less, in just about all other first world, democratic systems.  

AAZCD said:

Not happy with your insurance company? You can choose a different one, but wherever you go your costs and choices will be limited by state and federal laws and regulations. Not happy with insurance? You can choose to not participate. You will still be able to receive healthcare if you walk into an emergency room or are in a situation where an emergency medical response has been requested.

Yes, but it took government with the ACA to force Insurance companies in covering all those state areas. Why said areas exist however, I have no idea (and why so much of our healthcare keeps free market economics from working may be a thread unto itself).

And... just go without? I can't legally go without CAR insurance, why is personal health insurance so different? Heck, depending on living situations, where your home is and what job you have you need that car to survive. Why should you be allowed to go without when we know the alternative for thousands has been bankruptcy?

I live in Canada. I like the Medical coverage we have and find that is is much more egalitarian than what is available south of the border. It is far from perfect but it is better than the nothing that over 10% of the US population is forced to live without. For every "Thank God I have rich-man's insurance to cover my disease" story, there are a thousand "sucks I gotta watch my kid die cause I don't have insurance" story.

What I observe is that National Health services like those in Canada and the UK differ from US policy in that the services act as a fiduciary for the patient and not the industries shareholders. The focus of the medical industry in the rest of the world is not to make doctors and insurance companies wealthy; it is to provide basic healthcare to the population regardless of income.

I am free to change or lose a job and still know that I am covered for medical emergencies. Don't give a berkeley if my medical problem is pre-existing or not. I am free to buy more coverage if I want or go to the States and buy a set of new knees if it suits me.

That I can see, insurance companies add nothing to the healthcare experience except for a huge deadweight of administrative overhead.Correct me if I am wrong here.

Pete

In reply to Toebra :

Rationing is taking place right now. It's just the individual choosing to forgo healthcare due to expense because of the situation it would put them in. This means that we as a society are leaving our most vulnerable without healthcare simply because they can't afford it. There's no way one can argue we have a moral society in that context. Especially since, by and large, many of the large expenditures could be avoided by having at least some baseline access to healthcare.

Healthcare isn't an elastic good.

FYI for those who care about numbers:

Medicare for all is predicted to cost $28 - 32 trillion over the course of 10 years (2.8T to 3.2T yearly.)

Medicare last year cost $532 billion.

Americans spent $3.65 trillion privately last year on healthcare.

Profits by insurer are a bit hard to come by but they appear to be in the 5+ billion dollars per quarter range in 2017 for the 5 largest insurers.

Cut a war here, an aircraft carrier there, a couple military industrial complex contracts over there and suddenly you're talking real money. I don't see how this isn't feasible simply by scaling back some of the military spending and rolling in the income already spent on healthcare.

I was trying to stay out of this too.

The0retical said:

In reply to Toebra :

Rationing is taking place right now. It's just the individual choosing to forgo healthcare due to expense because of the situation it would put them in. This means that we as a society are leaving our most vulnerable without healthcare simply because they can't afford it. There's no way one can argue we have a moral society in that context. Especially since, by and large, many of the large expenditures could be avoided by having at least some baseline access to healthcare.

Healthcare isn't an elastic good.

FYI for those who care about numbers:

Medicare for all is predicted to cost $28 - 32 trillion over the course of 10 years (2.8T to 3.2T yearly.) https://www.crfb.org/blogs/how-much-will-medicare-all-cost

Medicare last year cost $532 billion. https://www.pgpf.org/budget-basics/medicare

Americans spent $3.65 trillion privately last year on healthcare. https://fortune.com/2019/02/21/us-health-care-costs-2/

Profits by insurer are a bit hard to come by but they appear to be in the 5+ billion dollars per quarter range in 2017 for the 5 largest insurers. https://www.axios.com/profits-are-booming-at-health-insurance-companies-1513302495-18f3710a-c0b4-4ce3-8b7f-894a755e6679.html

Cut a war here, an aircraft carrier there, a couple military industrial complex contracts over there and suddenly you're talking real money. I was trying to stay out of this too.

^This

50 years ago this nation put men on the moon using nothing more than slide rules and rudimentary computers.  Why can't we solve this?  The complaints that single-payer or "Medicare-for-all" will be too expensive are sort of moot when we spend a trillion dollars on developing and deploying one fighter jet (F35 program).  Our priorities as a nation are out of whack, and we can easily solve this problem since so many other countries have provided the blueprint to do so.  Will it be perfect? No, but tell me what is?

The government will not cut spending and then re-allocate it to something like Medicare For All. Too many hands on both sides of the aisle are partaking in defense contracts; likely the same will happen for medical contracts.

I instead foresee an increase in taxes across the board for minimal gain. Likely harping about tax the rich, but then middle class still gets screwed.

The0retical said:

In reply to Toebra :

Rationing is taking place right now. It's just the individual choosing to forgo healthcare due to expense because of the situation it would put them in. This means that we as a society are leaving our most vulnerable without healthcare simply because they can't afford it. There's no way one can argue we have a moral society in that context. Especially since, by and large, many of the large expenditures could be avoided by having at least some baseline access to healthcare.

Healthcare isn't an elastic good.

FYI for those who care about numbers:

Medicare for all is predicted to cost $28 - 32 trillion over the course of 10 years (2.8T to 3.2T yearly.)

Medicare last year cost $532 billion.

Americans spent $3.65 trillion privately last year on healthcare.

Profits by insurer are a bit hard to come by but they appear to be in the 5+ billion dollars per quarter range in 2017 for the 5 largest insurers.

Cut a war here, an aircraft carrier there, a couple military industrial complex contracts over there and suddenly you're talking real money. I don't see how this isn't feasible simply by scaling back some of the military spending and rolling in the income already spent on healthcare.

I was trying to stay out of this too.

One thing to point out here- for all of us who get employer paid insurance, the tax increase to pay for single payer would not be noticed at all- as it would be just transferred from going to one pool of money to another pool of money.   Yea, taxes would go up- big deal- the part of my compensaiton that pays for my healthcare will more than cover it.  Does it really matter if the money goes to Blue Cross or Medicare?  

Robbie said:

So for the proponents of single payer - I'm hearing of a lot of issues with the current us system (and I don't disagree they are issues). What I'm not hearing is the logic behind how a single payer solves those problems. Can you lay it out for me?

Example: 

Problem 1 - US healthcare system sends too much profit to insurance company CEOs, single payer system solves that by annexing their jobs, therefore CEOs are out of work, and we assume the single payer can do the role while paying someone less, therefore we no longer have to pay their profit, problem solved. (obviously this is a shrill example). 

Problem 2 - etc. 

As often happens with discussions like this, the problems are many and easy to come by, and solutions are rarely simple and all-encompassing. I hear the problems. I see the problems. I agree they are problems. I don't see the link between single payer and the solutions. 

CEO's are welcome to be division directors of the medicare branches.  They have jobs- but instead of CEO jobs, they will be paid on a very regulated government pay scale.  Which- relative to the nominal US pay, is REALLY good for the top administrators.  Relative to CEO's, it's a massive cut.  But their positions can be maintained.

Again, having watched CEO's to their jobs for many years, I HONESTLY wonder if they are really worth the kind of compensation they get here in the US.

The big losers to single payer will be the share holder.  Again, that raises the question if it's really ethical that profits can be made deciding how I can use my healthcare dollars.  

Health Insurance companies have to pay a certain percentage of their income back out for healthcare. Because of this, there can be minimal interest in seeking the lowest possible price- as long as more money comes in than goes out, everything is fine! They profit. Hospitals and other health care providers obviously know this, and seek to maximize profits. If somebody really *cared* about premiums and health care cost, they could reduce prices overall. Look at what Marilyn Bartlett did in Montana. 

Others decry paying for something they are not going to use. I understand this. I don't want to pay for somebody else's house, or car, myself.  Medical care is a bit of an odd case, though.  Life is one of the things called out in the United States Declaration of Independence and guaranteed by the Ninth Amendment. So, it seems as a society, we have an obligation to take care of others that can't take care of themselves. Some compassionate people have started to pay off the medical bills of others, just so they can keep living life without crippling debt. This is 100% voluntary, you say! Yes, it is. However, the system is already *making* you pay for other's health care in the form of increased medical costs. As noted above, it's best for everybody not profiting from the current state of affairs to reduce overall medical cost so that more of their money can flow in directions they want it to flow in. One thing we can all agree on is that paying for somebody else's malicious theft is something we don't want to do, though.

So, even if you don't think that a government run (single payer) healthcare system is a good thing, it may be that you'd agree that the healthcare system could use a reform, a bit of an overhaul to patch the leaks and add a bit of aero.  There are many steps that could be taken to reduce health care costs, but they would affect the current very profitable system. Are you willing to increase equity for all at the expense of a few, so that more people can use the sweat of their brow as they see fit? 

 

AAZCD said:

In reply to alfadriver :

Not happy with your insurance company? You can choose a different one, but wherever you go your costs and choices will be limited by state and federal laws and regulations. Not happy with insurance? You can choose to not participate. You will still be able to receive healthcare if you walk into an emergency room or are in a situation where an emergency medical response has been requested.

Working for a private air medical provider, we respond when requested, and care is provided. Some people pay, some people don't. Some are insured, some aren't. They all get the same care. Billing will happen, but nobody is going to prison for not paying.

I have landed a helicopter in someone's back yard when they were having a heart attack. Within 30 minutes they are in the city getting a heart catheter, regardless of insurance or ability to pay. Even they have the choice to opt out unless they are not alert and oriented.

I have also been called to a place where a person was thought to be having a stroke. After arriving on scene it was determined that they just had low blood sugar. They were treated on scene and recovered from the condition. Medically they did not need to be flown to a hospital, but EMTs had called us and treatment was provided. The patient refused to be released and we were obliged to transport.

There are problems with the US healthcare system, but everyone can get access to a level of care. Read Toebra's "War and Peace" thread.

You make it sound so easy.  It's not. To be employed, I HAVE to have health insurance.  And to do that, I HAVE to choose the choices made for me.  I don't actually have a choice.  If you do, that's awesome.

And with the limited insurance coverage comes limited choices of who can provide the care- as they have to be on the list of approved providers.

A single payer system means that every single doctor, including eye and teeth, are available for me to go to.

In reply to alfadriver :

That's a whole other pool of money I meant to remark on as well but forgot. It would likely less expensive for my employer (who pays 100% of my insurance premium) to go to single payer considering what is currently paid out for the employees policies. My previous employer paid 75% of the policy and I was still paying $600/mo for my family. Even if I had to individually absorb half of that I'd likely be fine with it.

There's money to be had I just think we need the political will.

In reply to FuzzWuzzy :

Not saying that our defense budget will be shrinking anytime soon.  The military-industrial complex is real, and a ton states would be up in arms if that were to happen.  As you say, too many hands in that cookie jar.  Government already has contracts for medical care with various companies, what many people don't realize is that these types of contracts already exist (my state has transitioned the Medicaid program to managed care, contracted with insurance companies who set up health plans with provider networks and pay claims out of the money they receive from the state per person).  In reality, it wouldn't be very hard to transition to a single payer system as the role of the insurance company wouldn't change much. However, they would not make as much profit as they do now as they would lose control over setting the reimbursement rates.  But, for the average consumer the transition could be relatively seamless, provided the current networks remain stable and doctors accept whatever the reimbursement rates will be.  Part of the problem now is that, at least for Medicaid (and to a lesser extent Medicare) many providers will not participate in the program because the reimbursement rates are too low per patient.  I think the advocates of single payer aren't framing their argument correctly.  They keep saying that private insurance will go away.  Problem with that is right now private insurance is most of the infrastructure of our healthcare system, so if you take that away what's left is basically unworkable.  They should highlight how single payer will work with private companies to provide coverage to everyone, because realistically that's what will happen.  I believe the ACA was intended to be a step towards that, but ideology seems to have thrown a wrench into that. 

RE: I don't want to pay for others for something I don't use....

Yet they also pay for car insurance, with the 100% hope that they don't ever use it.  Some of that money that goes to car insurance companies will go to pay for other people's accidents.  You can go through life never using your car insurance, pay many thousands for it- and all of it goes to either pay for others, overhead, or profit.  That's exactly how insurance works.  It's socialized coverage of accidents.

Same for home and rental insurance.

Robbie said:

tuna55 said:

My wife has a lot to say on this subject. She has a rare disease, for which much research is being done in emerging medicines. She has friends through various groups all over the world. The rest of the world (outside the US) has zero access or long waiting times for much of the treatment options we've already gotten. This is aside from the fact that every single advance in treatment happened here because there is money to do so.

 

The healthcare costs for my family likely eclipse all but a few on here, and yet I would not trade it for a single payer system.

This. Whenever someone tries to tell me the US doesn't have the best healthcare, I have a forehead slap moment. Yes, it can be improved, but in general you get what you pay for (and we PAY for our health care). 

Single payer is something I just don't really see the advantage of. What if we just said cars cost too much and therefore we should switch to a single manufacturer system? For efficiency sake. 

Improper analogy.  What you are saying here is "single provider."  A more proper analogy is that you can still buy any car from any manufacturer, but there is one bank that handles the loans instead of thousands.

alfadriver said:

The0retical said:

In reply to Toebra :

Rationing is taking place right now. It's just the individual choosing to forgo healthcare due to expense because of the situation it would put them in. This means that we as a society are leaving our most vulnerable without healthcare simply because they can't afford it. There's no way one can argue we have a moral society in that context. Especially since, by and large, many of the large expenditures could be avoided by having at least some baseline access to healthcare.

Healthcare isn't an elastic good.

FYI for those who care about numbers:

Medicare for all is predicted to cost $28 - 32 trillion over the course of 10 years (2.8T to 3.2T yearly.)

Medicare last year cost $532 billion.

Americans spent $3.65 trillion privately last year on healthcare.

Profits by insurer are a bit hard to come by but they appear to be in the 5+ billion dollars per quarter range in 2017 for the 5 largest insurers.

Cut a war here, an aircraft carrier there, a couple military industrial complex contracts over there and suddenly you're talking real money. I don't see how this isn't feasible simply by scaling back some of the military spending and rolling in the income already spent on healthcare.

I was trying to stay out of this too.

One thing to point out here- for all of us who get employer paid insurance, the tax increase to pay for single payer would not be noticed at all- as it would be just transferred from going to one pool of money to another pool of money.   Yea, taxes would go up- big deal- the part of my compensaiton that pays for my healthcare will more than cover it.  Does it really matter if the money goes to Blue Cross or Medicare?  

Not being political since both sides are guilty in some way of this...

The thing that ticks me off is the tax structure that favors big corporations in an effort to get them to stay here, and doesn't tax the imports from those companies when they move anyway.

Using 2015 numbers from the US Treasury website, the entire discretionary budget for the US government was $1.11T.  The amount of tax breaks given out (the majority of which went to the top 4 corporations) was $1.22T.  I would love to see the trillionaire Walton family, Apple, BP, and the other big "welfare corps" start paying what they owe instead of hundreds of millions per year to execs.  I have to chuckle when people get ticked at someone who bought a steak with food stamps, but turn a blind eye when some congress member passes a bill to give a billion dollars back to WalMart while the CEO makes $23M a year, and the median income (not the lowest paid) for all other employees is $19,177 which qualifies most of them for Medicaid and food stamps. source.  Not only are my taxes (proudly and happily) paying for their Medicaid, but I paid even more to WalMart so they could walk away from taxes.

I don't get the car insurance thing at all.  Sure my fellow man can give me a heart attack most days.  But that's because he changed lanes ten feet in front of me without using that annoyingly hard to operate turn signal which emits a bright flashing light which at least gives me some warning.

Not sure how any of my fellow man can will increase my rate of prostate cancer on a day to day basis.

Same thing for my cholesterol.  Migraines?  Well don't watch the news for a start.

Let's see?  Deep vein thrombosis?  Get up off my fat ass.  That might help.

What else am I missing that is under my control and doesn't need 300+ million Americans to subsidize for me?

Now put those schlubs in cars around me?  Require them to have insurance due to their increased likelihood of running that red light y'day whilst on their 'phone?  I think requiring them to have car insurance is fair.  

Requiring them to have health insurance because I haven't been to a doctor in over twenty years.  I'm gonna say that's not fair despite the benefit to me.

As for the military.  Pretty much the same stchick.  I'd love for the Pentagon to give me a battery of howitzers/hellfires/Stingers and an endless supply of bullets to protect myself but they'll do a better job most of the time instead.

Also how far does anyone on here genuinely think that the Pentagons budget ( less than $700b. ) will go?

As I intimated it's a big complex problem.  'Single Payer' is jargon nothing more.  It's damn near achieved the status of a lie.

And no a thousand poor American children ( God why does it always have to be the children? ) do not die because one rich person has an ingrown toenail removed same day as diagnosis. "The poorest 20% of Americans are richer on average than most nations of Europe." J.D. Agresti.

alfadriver said:

One thing to point out here- for all of us who get employer paid insurance, the tax increase to pay for single payer would not be noticed at all- as it would be just transferred from going to one pool of money to another pool of money.   Yea, taxes would go up- big deal- the part of my compensaiton that pays for my healthcare will more than cover it.  Does it really matter if the money goes to Blue Cross or Medicare?  

The0retical said:

My previous employer paid 75% of the policy and I was still paying $600/mo for my family. Even if I had to individually absorb half of that I'd likely be fine with it.

This. I was paying $300 a WEEK for family health insurance while employed full time. It wasn't even a spectacular plan. If that same money went into a more efficient, streamlined system with less waste and fewer profits for shareholders, I'd not mind. If prices went down because the system wasn't profit driving and more efficient, I'd be overjoyed. 


 

In reply to The0retical :

You just destroyed some huge % of the economy that pay taxes to support Medicare, VA benefits.... Funny isn’t it. Unintended consequences are a tough cookie. 

nutherjrfan said:

"The poorest 20% of Americans are richer on average than most nations of Europe." J.D. Agresti.

 

Factually incorrect. The wealth of the poorest nation in Europe far outstrips the wealth of most individuals. J.D. should learn how to phrase things properly.

Now, to the point he was probably TRYING and failing to make, the income available to the lowest 20% of the population in the USA may exceed that of the same population in most European countries. However, it isn't generally an apples to apples comparison. If your cost of living his higher, even if you have 5x as much money, it just won't go as far- in fact, it may not even go as far, and you might have trouble affording housing, nutritious food or... guess what? Medical care. In the Euro countries, you're covered for medical care (including psychiatric care), which to many families in the US is their single largest annual expense. 

As someone who has lived in multiple countries with multiple different health care systems, I can probably provide a little first hand experience with the various options:

• UK - the NHS is a "true" single payer system. You pay for it as part of your National Insurance payments (which cover the basic state pension, basic health care and IIRC basic unemployment). The NHS runs almost all the hospitals and employs the doctors and nurses working there. The system works such that you either end up in A&E (the equivalent of the ER) after, say, a car accident or a night out or you go see your GP at their local practise for basic health care and referrals to a specialist if necessary. Either way the NHS is free at the point of service delivery - in England (but not Scotland) you may have a copay for your meds but as long as you are a resident in Britain you don't have to hand over your credit card before you see someone. Dental and vision is usually not included - dental mostly because you can't find an NHS dentist, at least not where I lived.
  You can still buy private health insurance policies that tends to get you faster access to specialists (who often work for the NHS and run a private practise) and possibly private specialist hospitals.
• Germany has a more hybrid system - they mandate everybody has to have health insurance but you get a choice of insurance providers that are pretty tightly regulated to ensure they all cover the same basics, although some of them may cover extras for extra premiums. Dental coverage is so-so and getting worse, same for vision. The insurance is more expensive than in the UK, which is partially due to it not being a true single payer system, but the fact that universal coverage is mandated expands the risk pool and keeps the premiums lower. Doctors are usually self-employed and their practises tend to be better equipped - for example, your GP in the UK will send you to the local hospital for an X-ray, whereas the practise in Germany probably has their own X-ray machine.
  "Regular" hospitals at least used to be often owned by the local city or state and operated more along the lines of a public benefit corporation than a for-profit enterprise. Universities usually also have their own hospitals and teaching hospitals that are state financed as most of the universities are public institutions.

The system in the US is a lot more profit oriented, plus, lacking a universal coverage mandate, has a much smaller risk pool in comparison - basically comprised of employees at companies that offer health care and those people who have ailments that require them to have health insurance or croak. If you're healthy there is not a lot of incentive to buy health insurance of your own so it doesn't balance out the number of people who are a lot more likely to use health insurance.

The other, fairly uniquely US part of this is that it's been documented fairly well by now that hospitals buy up competitors and local doctor's offices in an often successful attempt to become the dominant and/or only provider, then ratchet up prices. Plus, private equity is also pouring money into buying up specialist practises and they don't do that for charitable reasons either.

The US actually has three single payer systems (Medicaid, Medicare and the VA). The former two have shown that they have the market power to negotiate prices down much harder than private for-profit insurance companies.

To give you an idea just of the health insurance cost difference, health insurance premiums in Germany would be probably about double what I'm paying right now for my wife and I in the US. The problem is that IIRC I'm paying about 20% of the premium and my employer pays the other 80%.

Rationing is going on, sort of.  Read the thread I linked above.  Everyone in this country can get care if they need it, everyone.  If it is not an excellent service, why would people who could literally go anywhere in the world come here.

Hot tip.  If you just agree to pay something, $5 a month say, you don't go to collections and get forced into bankruptcy due to medical expenses.

Single payer allows access to any doctor?  No.  Check out what percentage of doctors opted out of the "Affordable" "Care" Act plans

I think a big part of the problem in trying to discuss this is the overwhelming lack of understanding regarding how things are now, and how the changes proposed can reasonably be expected to impact the situation.  Routinely the terms "healthcare" and "health insurance" are conflated.  The thing that makes it the most difficult is there is no desire to really fix things, rather the impetus is to placate constituents. 

It is not a simple problem, and what has worked in other countries can't really be reasonably expected to work here.

For example:

People talk about going to a Canadian style system in the USA.  We have like 100 times the number of illegal immigrants here per capita than Canada does, or that was the estimate last time I checked.  This will obviously impact how that sort of system would work here.  While I appreciate the desire to discuss the subject in an apolitical fashion in keeping with the terms of use for this website, I don't really see it happening.  We are not talking about "healthcare," we are talking  about healthcare insurance, a subject that is inextricably linked to politics

That being the case, I am out.

alfadriver said:

AAZCD said:

In reply to alfadriver :

Not happy with your insurance company? You can choose a different one, but wherever you go your costs and choices will be limited by state and federal laws and regulations. Not happy with insurance? You can choose to not participate. You will still be able to receive healthcare if you walk into an emergency room or are in a situation where an emergency medical response has been requested.

Working for a private air medical provider, we respond when requested, and care is provided. Some people pay, some people don't. Some are insured, some aren't. They all get the same care. Billing will happen, but nobody is going to prison for not paying.

I have landed a helicopter in someone's back yard when they were having a heart attack. Within 30 minutes they are in the city getting a heart catheter, regardless of insurance or ability to pay. Even they have the choice to opt out unless they are not alert and oriented.

I have also been called to a place where a person was thought to be having a stroke. After arriving on scene it was determined that they just had low blood sugar. They were treated on scene and recovered from the condition. Medically they did not need to be flown to a hospital, but EMTs had called us and treatment was provided. The patient refused to be released and we were obliged to transport.

There are problems with the US healthcare system, but everyone can get access to a level of care. Read Toebra's "War and Peace" thread.

You make it sound so easy.  It's not. To be employed, I HAVE to have health insurance.  And to do that, I HAVE to choose the choices made for me.  I don't actually have a choice.  If you do, that's awesome.

And with the limited insurance coverage comes limited choices of who can provide the care- as they have to be on the list of approved providers.

A single payer system means that every single doctor, including eye and teeth, are available for me to go to.

Just a one point  

No Every Doctor cannot work for you.  First some are obligated to the military, tribal medicine, or research, one corporation or another. One insurance plan or another etc.  

Sorta. If they are taking patients and you're paying in cash that opens LOTS of doors since all your paperwork becomes basic notes.

Also some food for thought- if you're going back to college and you're past the 26 year mark of being able to go on your parent's insurance as a dependent, colleges now are starting to offer insurance through the schools. I have to look at them now- even more complexity on top of the possibility of student loans.

Toebra said:

  Everyone in this country can get care if they need it, everyone.

Wrong.  You cannot be turned away from emergency services if you are in immediate danger, but if you have cancer or some other condition that is not an immediate danger to your life you will not be treated unless you have a way to fund the treatment. 

If you have a medical problem and need treatment but no insurance you will have a hard time finding a doctor that will work with you.  A friend of mine had his appointments canceled for lack of health insurance and denied treatment until he was damn near dead and the emergency room could not turn him away.  The emergency room services and extended hospital stay was massively more expensive than outpatient treatment would have been.

If you are over 50 it's unlikely that you can buy real health insurance on the open market.  I tried to get an interim policy and was turned down.  The ACA is the only way I can get coverage and I'm pretty damn healthy for being over 60.  The insurance companies don't want to write policies for older people.  It's not profitable.  I'm all in favor of single payer, or a public option, or just leaving the ACA alone.  Going back to a total "free market solution" is just going to bankrupt and kill people. 

We spend more per person on healthcare than any other country and it's a tax on our productivity and competitiveness.  That needs to be fixed.