There’s an interesting graph here about Medicaid spending in Illinois whose pattern (I’m pretty sure) applies to all of health care spending:
Most of the cost is centered on a few very sick people. If we want to control health care costs, we have to control the cost of treating them.
As for how, I’m not sure.
With all the news about the healthcare reform implementation on the federal level, I wanted to check up on the couple of states that were going to/had passed single payer implementations.
California: I thought it got passed into law, but it turns out it was passed twice in the legislature and twice vetoed by then Gov. Schwarzenegger. And with Democratic supermajorities and a Democratic governor… nothing. From the article it seems like one of the main reasons is the California Nurses Association isn’t pushing for it now for tactical reasons (they believe it will go through ballots for repeal anyway, so they have to fight it there). So California is leading the states with Obamacare, but no longer with single payer.
That leaves Vermont. Single payer is law in the state, but won’t be implemented until ~2017. Looks like Vermont is focusing on its exchange, and it also needs a waiver from the Federal government and to raise funds.
So it won’t be for a while now, but there’s at least one state that will have single payer. It won’t be “true” single payer, as private insurers can still insure, but it’ll be as close as you can get with that caveat.