more time to patient care) physicians' average take home incomes wouldn't change under single payer. Of course, some doctors' incomes would go down - e.g. those who currently enjoy a particularly rich payer mix. On the other hand, some would see an increase - e.g. those currently caring for many Medicaid or uninsured patients. - answer contributed by Dr. Steffie Woolhandler How will we keep drug prices under control? When all patients are under one system, the payer wields a lot of clout. The VA gets a 40% discount on drugs because of its buying power. This "monopsony" buying power is the main reason why other countries' drug prices are lower than ours. This also explains the drug industry's staunch opposition to single-payer national health insurance. Why shouldn't we let people buy better health care if they can afford it? Whenever we allow the wealthy to buy better care or jump the queue, health care for the rest of us suffers. If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded. Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn't serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important. Moreover, when the wealthy jump the queue, it results in longer waits for others.