political process also would determine which medical services are available, to whom and under what circumstances. In today's political environment it doesn't take much to imagine what that might be like. Single payer systems minimize the involvement and responsibility of individuals and families The corollary to increasing government decision making and politicization is a diminished role and voice for individuals. In a single payer system, there is no role for the average person except to consume service. Individuals have no place in choosing systems of care and financing, little leverage over institutions that directly and significantly affect their lives, and only a faint voice when dissatisfied. Once we establish a single payer plan, we cannot easily undo it Some reform plans can be undone. A single payer system cannot. If we choose a single payer system, we will dismantle organizations and processes such as health insurers and plans. We will not easily or quickly rebuild them if the new system fails to satisfy us. And single payer offers no guarantees on cost and quality. Some countries that have single payer systems have had lower cost-growth than the United States. However, in order to restrain cost, single payer systems require centralized government control of health care prices and use of services--and the intrusiveness that goes with it. But our experience with heavy regulation on the state level raises questions about whether central controls really are effective. Organizational vitality and innovation The structure of single payer systems discourages diversity and thus discourages