That would still leave a myriad of insurers for doctors to deal with, making medical decisions, and inflating the cost of health care.I have been a fierce critic of single payer in the past. After spending enough hours debating about it and learning about how the new health care law was intended to work, and why it was so imperative that something be done about health insurance in 2010-11, I've changed my attitude about it.
I could name 3-5 changes we could make to PPACA (or provisions we could add to it) and we would basically have single payer. Consolidated, they would be:
1) No employer mandate, instead offer tax breaks or other incentives to companies that discontinue providing health insurance if they pass along at least 80% of their savings to employees in wages. One example of such an "incentive" is to reinstate the "Cadillac Tax" and make it applicable to all companies that insist on continuing to buy their employees' health insurance, starting in 3 years (giving them that amount of time to decide to stop).
2) Make everyone eligible for subsidies, assuming their insurance costs more than (x)% of their mAGI. No family glitch, no 400% poverty level subsidy cliff, no disqualification for subsidies based on an employer's offer of coverage. Literally everyone should be eligible for subsidies if the cost of insurance exceeds a certain % of their mAGI. Some people will not need the subsidies if the total cost of premiums is still less than 9.5% of their income, but there should be no one that is arbitrarily excluded and screwed over.
3) Restore the individual mandate, but allow people to buy skinnier, higher-deductible plans than are currently allowed.
4) Loosen the restrictive rules around HSAs. Let everyone set up an HSA regardless of the insurance plan they choose. Make it easier for people to save some of their own money for health needs.
If we did these things, it would cause a) health insurance to become divorced from employment, b) every individual to independently choose the insurance they feel is right for them, 3) those that are currently being arbitrarily hosed by the law's glitches and provisions would get a more fair deal, leveling the playing field for customers, 4) everyone's personal health insurance expense to be a function of their income, which is an inherent feature of single payer.
The one major downside? It would cost more federal dollars. Whoopdy doo. We're spending the money already anyway, just doing it stupidly and arbitrarily unfairly.