It is also worth noting that the single payer model doesnt imply that the public sector has to do all the delivery. Most single payer systems are veering away from a monolithic-everything-run by the state model towards a much more mixed model.

This is happening in the UK but also in Sweden and Spain. In Catalonia Adeslas a big insurer and healthcare provider has run the primary and secodnary healthcare systems at Alzira for a decade. It claims to be 25% cheaper than the state.

In Sweden many regions are now outsourcing care of the elderly, primary care and domicilary care to private companies rather than carrying it all out themselves. About $1 billion of business should transfer to the private sector over the next 18 months.

We cover this on our new website healthcareeuropa.com.

I think of traditional single payer systems as the T34 approach. This was the tank that won the second world war. The USSR pushed almost all its tank production to the T34, a crude but very effective tank. Germany had far more variety with more sophisticated engineering but couldn’t produce the volumes. The single payer model works for me when it is a one size fits all T34 or Model T. But what do you do when consumers become more choosy and start demanding aromatherapy, natural birthing techniques, 88mm guns or yellow cars?

So it will be very interesting to see if outsourcing works.