No version of single payer fits the US. Most countries in the world with universal care do NOT use the single payer model.
Most countries use a dual-payer, or insurer-as-utility model. In this mode, the insurance companies are retained, but heavily regulated (much like the ACA does) as to what sort of markups they can put on their products. They want a rate increase, it needs to be approved by a rate board, much like a traditional electric or gas company.
This model is better for several reasons:
- The risk is on the insurer, not the taxpayer.
- The insurer is an expert in pricing both the product and their own risk; the government doesn’t know how to do this, and if they had too, WOULDN’T do it very well (because the government doesn’t like to say NO to anyone.)
- The patient still gets to shop insurance policies for what’s best for them, and competition for those patients acts to keep rates low.
Then, you can pretty easily add to that program HSA’s, which are one of the few known ways to actually lower health care costs.
My faves internationally? Switzerland and Singapore.