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Paradigm Shifts: "The earth isn't flat?!"


The idea of a single-payer system is actually very simple: have a single governing entity – not necessarily "the government" – that pays for/provides health care.


The benefits are enormous, especially in regards to cost. But there are lots of pitfalls in a truly communal single-payer system because it doesn't address some of the quirky aspects of our current health care delivery system.


Foundational Paradigm:

All three dimensions of health care (Patient, Provider, and Place) must be equally active in controlling cost and quality of care in order to obtain the greatest benefit. A combination of incentives and disincentives ensures that the responsibility is spread among the three while simultaneously considering  their unique characteristics.
The Patient

The patient is ultimately responsible for informed medical decision-making and for paying the cost of their health care through taxes, premiums, etc.


In taking into account what is required of the patient, consideration should be based on four categories:


A:  Pediatric population (birth to 18)


B:  Chronic illness population (birth to death)


C:  Geriatric population (70 to death)


D:  Adult population (18-70)

The Provider

The provider is responsible for educating the patient and being the best steward of health care resources.


In taking into account what is required of the provider, consideration should be based on three categories:


A:  Medical (includes all services requiring non-invasive physical examination):

     (1)  All general medical specialties and subspecialties

     (2)  All physically interactive therapies (physical and occupational therapies)

     (3)  Dental

     (4)  Vision


B:  Mental Health (includes all services requiring non-invasive non-physical examination:

   (1)  Psychological services

   (2)  Psychiatric services

   (3)  All speech therapies


C:  Surgical (includes all services requiring invasive and physical examination):

   (1)  All general surgery specialties and subspecialties

   (2)  All anesthesia specialties and subspecialties

The Place

The place is a building or program where health care is delivered based on two categories:


A:  Inpatient care (includes any program requiring an overnight stay):

   (1)  Inpatient hospitalizations, including 24 hour observations

   (2)  Long-term skilled nursing facilities

   (3)  State-supported living centers and state schools

   (4)  Nursing homes

   (5)  Residential treatment facilities

   (6)  Group homes

   (7)  Halfway homes (in conjunction with the legal system)


B:  Outpatient care (includes any program that does not require an overnight stay):

   (1)  Partial hospitalization

   (2)  Intensive outpatient

   (3)  Ambulatory care centers

   (4)  Private provider offices and practices

   (5)  Therapeutic services (occupational, speech, vision, dental, physical, ABA)

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