Again, Michael, miss information about single payer dominates in the US. First, there are no reasons why the advantages of single payer are dimished by size. Second, once again look to Canada. As Kari2 explained in a post on this article, the single payers in our system are the provinces, with common standards set by the federal government as conditions of significant federal funding. Single payer means one payer in any given geographic region, not necessarily one national payer. And again one more time, learn from Canada, as Saunders advocates--the way to get there is not state by state, but by a federal initiative that makes funding to the states for health care dependent on adopting single payer.

There are a few things Americans should also learn from failures in the Canadian system...include dental and pharmaceuticals in the plan from the start. Our notion of adding those on later didn't work.