A single payer system standing alone wouldn’t be enough to control costs.

And enlightened single payer would have to move the delivery system away from the current fee for service model.

That’s the take of Merrill Goozner, editor of gooznews.com.

“There is good reason to believe that the administrative efficiencies of a single payer system could well pay for insuring all the uninsured,” Goozner told Single Payer Action. “The problem is that medical cost inflation has really been no different under Medicare than in the private sector for the most part. It’s been within a point or two year after year. Sometimes Medicare is higher and sometimes the private sector’s higher. But the problem of health care cost involves the underlying delivery system issues. We have people doing piecework delivery — ineffective care just to run up the bill.”

“Going to single payer may have a onetime administrative savings that would enable you to insure all the uninsured. But we would still confront the very serious problem of health care costs rising at twice the rate of inflation every year. And we really do have to end that if we’re going to have a sustainable health care system under whatever model we move to.”

Goozner recommends an article by Dr. Arnold Relman in the current issue of the New York Review of Books.

Relman puts forth a proposal for a single payer insurance system coupled with the elimination of the fee for service delivery system that is driving up costs.

“It would include a single public payer that guaranteed comprehensive health care for all, funded by a progressive tax whose proceeds would be dedicated to medical care,” Relman wrote. “This insurance and funding plan would be combined with a delivery system, overseen by a public agency but managed entirely on a not-for-profit basis by privately organized doctors and hospitals. The delivery of care and the use of health resources would be the responsibility of organized multispecialty groups of salaried physicians and other health professionals, which would include adequate numbers of primary care doctors.”