Just two days ago I read an interview with the CEO of Artna. He stated that we need a very open public policy dialogue about single payer. He also stated that just as the insurance industry  can provide market efficiencies for Medicare and Medicaid; so it could for single payer! In other words, government might be the single payer, but the managers would likely be  Insurance agencies that would be established on regional bases to address the population, healthcare priority and geographic differences of groups of recipients.