A single payer system does not preclude the affluent from paying, outside the system, for a penthouse suite in the hospital, or for cosmetic surgery, or for any other services that should not be part of a publicly funded program anyway. Other than the assurance that everyone would have coverage for health care, there is even a greater good that single payer would bring to our nation. Making available to everyone preventive and public health services would significantly improve the level of health of our entire nation. Reduction of communicable diseases and reducing the higher costs of untreated chronic disease helps all of us. Healthy individuals make for a healthier work force, with less lost time at work, greater productivity, and a more positive work environment.
Most proposals call for incremental and pluralistic measures.
Unfortunately, such approaches cannot meet the goals of universal, comprehensive, affordable health care. As an example, it was recognized that Medicaid was grossly inadequate in meeting the needs of insurance coverage of low-income children. Congress passed the Children's Health Insurance Program to expand the number of children covered. Yet, since enactment, the number of uninsured children actually has increased. Incrementalism will never provide universal coverage.