I applaud your intent. But the health care system you are describing would be “crushing” financially… imagine if one day, the government said everything you want in the country is free. How long do you think anything would remain on the shelves. But we are not talking about everything… just healthcare.

Unless you have worked in the delivery side of health care and the financing side of health care, you would not understand how the more “free” health care is the more it is used… and just as sadly abused. The reason single payer systems have such substantial personal responsibility components to their health care design is to prevent “abuse”.

In health care that are two ways to control health care “abuse”… the first is to make it expensive every time you use it and the second is to manage it. So let’s look at an two examples of the first case.

When I ran physician offices we found that patients with a $15 co pay were half as likely to come in as those with a $5 co pay. So were they “half” as sick. No. Instead if the visit were only $5, they would come in for stuff that somehow an extra $10 convinced them was not really necessary. With seniors the problem was even worse. Many seniors are lonely, they look forward to going to the doctor and many would come to talk with other patients in the waiting room and see the doctor for an “imagined” ailment. Clearly, these people need some social interaction, but the health care system is a very expensive place to get it.

I cannot tell you how often week-end warriors would come in wanting some sort of medical device or treatment, that while it would work, was the proper treatment. The proper treatment was to rest their injury, but the cheaper it was to give them the less effective, more expensive brace the more they would opt for expensive bad care rather than rest (very cheap care).

Money influences behavior anyone in the industry will tell you that. The goal is to set the price of healthcare where it is affordable and does not discourage people from using it but expensive to discourage people from abusing it. Not an easy challenge…

The second way to control abuse is “managed” or “rationed” care. Some form of “gatekeeping” is put in place to protect the most expensive segments of the health care system from being accessed and abused. In lieu of “cost” administrative controls like referrals, pre authorizations, generic substitution, etc. are used.

The best approach is a combination of the two… but in general government health care systems only use price, which means prices must be higher to avoid the system being crushed by abuse. If it were crushed by abuse and your were prepared to pay for that, then the average American would need to plan on spending almost 25% of their wages on health care.

Now let’s talk about funding. What is wrong with “taxing” corporations instead of having them provide health care. The simple answer is “corporate income” is not dependable… it goes up and down to much to build a funding system for health care around it. This is why every nation that offers universal health care funds it through the only two dependable tax systems out there… wages and purchases…

Europe uses both. Wages are taxed at 8% rather than the 15% it would take if we used a more managed care (control abuse through administrative controls) or Medicaid health care plan (control costs by horrible reimbursement rates) in this country. So how does Europe do it for 8% and the various proposals suggest we would need 15%? The answer is the VAT tax… Europe charges 19% on everything people buy. So to the average worker, they would take home 15% less and then lose 10% when they tried to spend it (though some of that 10% would go to other entitlements, it helps make up some of the “payroll tax shortfall”.

So how does employers paying for health care today differ than taxing them? Today, their income does not matter, they pay the premium whatever their income is… even if they are losing money they have to pay the premium. If we tax them that way, then what’s the point of substituting a lousy government health plan for the better health plan many employees enjoy today?

Finally, it is constitutionally illegal not to allow an opt out. The Supreme Court stretched to allow the government to charge a “tax” on those who opted out. Under our Constitution, the government can require the purchase of product or service, it can only tax. So it can tax wages and it can give you health care… they may be related but one is not dependent on the other… but they can require you to buy something… One reason the “opt out” tax was so low under ObamaCare is that they had to “sell” it as a tax and not a penalty.

Finally, understand it is not cheaper to provide single payer health care, it is actually more expensive. But that is a subject, I have written on before so I won’t repeat myself. For background purposes… I was the Chief Financial Officer of a large contractor that administered Medicare and Medicaid for the government in my career and an executive for one of the countries largest private health insurance companies in the country. I am now retired, so I don’t have “a dog in this fight”. Overall, private health insurance is a far better option even if we seek to have universal health care coverage than single payer… the real question is how should government operate to insure that health insurance is affordable and accessible by all citizens without screwing up quality, access, or choice.