Single Payer or Central Payer

These two concepts, single payer and central payer, are the same, if the payer exists at the federal level of government and only at that level.

However, each state developing its own single payer means the greed-driven, ideology-driven machinations emanating from state legislatures’ networking with healthcare businesses will creep into the cities, towns, and villages, like uncontrolled undergrowth in a rainforest which entangles forward movement. Vermont’s Green Mountain Care could be an example (

One properly structured, federal-level central payer could drain these 50 state-engineered swamps and thus could absolutely and significantly lessen healthcare business-political interaction within our healthcare system.

Okay now, Wait for it, Here it comes: The political rhetoric of infringement on states’ rights! While our politicians vociferously argue about this and appear on cable news programs righteously defending the Constitution and states’ rights, etc., etc., do you believe that any of the them, state or federal, really give a damn about an individual’s health care or worry about how their deal making with the healthcare business sector infringes upon the doctorpatient relationship?

Whatever happens with the American health care system: Whether ObamaCare is repealed or not; whether RomneyCare, Ryan’s Roadmap, HillaryCare, GreenMountain Care, or AnyOtherCare comes to the fore, the uncompromising, fundamental tenet for true reform is that equal access to sound, ongoing, non-conflicted doctorpatient relationships is the primary goal to be served by every part of our healthcare system. The dollar bill and ideology, although not necessarily bad goals, must be relegated to a supportive role for bringing to fruition the achievement of this far more important, altruistic reality, i.e., health care for everyone. Absent that, we remain stuck in our current, quirky, American quagmire begging for change, while we watch the politicians, healthcare corporate leaders, lobbyists, federal and state operatives, think-tanks, and others bob for the best position to siphon their individual swamp’s dollar-green slime into their own coffers.

A properly structured central payer can achieve true healthcare reform. Fifty single payers will not, nor will the previously proffered, convoluted tweakings of our complex, anti-doctorpatient relationship, dysfunctional system.


R. Garth Kirkwood, MD

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