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Q: But why make it state-dependent?

"But why make it state dependent if you're advocating for a single payor?"

This question was submitted by a friend and accountant. A "citizen-owned" statewide nonprofit allows citizens in each state to set their health care goal.

For instance, in Vermont, if the citizens there chose to pay more into their general health fund so that all preventative and all sick visits are covered, they could do so. As a Texan, with our ridiculously fierce independent streak, we would likely only do the minimum necessary, so our general health fund would only cover preventative visits.

Benefits of a state-specific plan:

  • It creates competition allowing for leveraging of contracts with pharmaceutical companies, medical device companies, and health insurance companies (for catastrophic coverage).

  • As we know, some states are healthier than others and poorer than others, etc., so it gives citizens more motivation to help themselves. There's something about the suggestion of one person's tax dollars going to help someone in a different state that generally sits poorly in Americans' minds.

  • It creates 50 nonprofits that pharmaceutical companies, medical device companies, and health insurance companies will have to haggle with; that builds even more competition to drive down the cost of everything.

  • Within the competition model, states will work to make sure provider compensation stays up because they will have to fight to keep their good providers. At the same time, patients' use of the system will keep providers' costs from becoming exorbitant because they'll have ample other providers to go to statewide.

  • Every citizen will learn what it's like to be a stakeholder in a company, how to read annual reports, to know what it's like to work with a board of directors, and how to take ownership of their part of a "big business."

So, in a sense, the single-payor ideal is more philosophical than physical, but it still ties the 50-state plan together, kinda like a new-agey constitution.

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