class care, assure universal access, and realize the administrative

class care, assure universal access, and realize the administrative savings that are possible only under a single-payer system;

• No out-of-pocket payments for medically necessary service;

• Hospitals which would remain privately owned and run, to be paid lump sum global operating budgets (built on their current operating budgets and projected changes at the start), rather than billing on a per patient basis. This would allow the virtual elimination of hospital billing and most internal cost accounting;

• Separate capital budgets. The separate appropriation of capital funds would facilitate rational health planning, and discourage hospitals from skimping on care in order to accumulate funds for expansion;

• A single, public payer. Singlesource payment is the key to both equal access and cost control. Public administration is far more efficient than administration by private insurers. Thus, it is a fact that private insurance overhead averages more than 13 percent, while Canada’s public program has an overhead of 0.7 percent and the U.S. Medicare program has an overhead of about three percent;

• Public accountability but minimal bureaucracy. Public accountability is essential, but should not be accomplished through bureaucratic intrusion in the details of clinical practice. A single-payer system permits the monitoring of patterns of practice, with more detailed reviews reserved for physicians displaying outlandish practice patterns. The case-by-case oversight characteristic of current utilization review methods should be minimized, as it is in Canada and in other singlepayer systems.

We all have our fear of change. We all have our unreasoning ideologies that are unaffected by facts (as distinguished from money). It is time to forget them and get on with the business at hand.

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