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A plan to convert the US to a single-payer health care system:
Step 1: Combine all existing Federally-funded health care plans into one single plan: Medicare, Medicaid, TriCare, the Federal Employee health insurance programs, the Congressional health insurance programs, etc. If the Federal government is paying for your health-care, it's through this one program. Naturally, all persons/families currently eligible through any of the subsumed programs are eligible for the new one. Let's call it "FedMed" (bad name, but it's short and distinct from any existing name).

Step 2: Fund FedMed through a separate tax. Basically, replace the current Medicare/Medicaid payroll taxes with a new FedMed Tax, applicable to all (no salary cap), with the rate set by the FedMed administrator according to anticipated demand and the desire to build up a trust fund. Allowing someone in the Executive to set tax rates isn't unheard of, since the law currently requires that the Treasurer adjust the tax brackets, exemption, and standard deduction amounts.

Step 3: Increase provider participation: A health plan is worthless if those who need it can't get it. So require providers who receive federal funds (in the form of grants, contracts, and (importantly) guaranteed or direct student loans, etc) to accept payment via FedMed. Make sure that the payments to FedMed providers are reasonable, so providers will want to get on board. Also, expand the current system of federal hospitals (like VA hospitals, and others if they exist) to include FedMed hospitals, with staff on salary, which accept FedMed patients.

Step 4: Increase FedMed patient participation. Initially, only folks currently eligible for Federal health care will be eligible for FedMed. That's a lot of people, but it still leaves out a large chunk. I am currently too young for Medicare, too rich for Medicaid, and am not current or former military, nor do I work for the government. I wouldn't qualify for FedMed. So slowly increase FedMed eligibility: Slowly lower the "retirement age" eligibility requirement: 65 this year, 64 next year, etc. Allow children in: anyone born after 2012 this year, after 2011 next year, etc. Give federal contractors the option of enrolling their employees in FedMed rather than private insurance. Then a few years later, require federal contractors to enroll. Set a policy of never kicking anyone out of FedMed (so federal employees have health coverage for life, once hired), etc.

It won't happen instantaneously, but over time (and within 30 years) 100% of the population would be covered by FedMed, and health care will be another perk of living in the US, like most of the developed world.


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Nationalizing the hospitals -- at the state level -- would provide easy expansion of those services.

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