Health care "reform" is at the head of the national agenda right now. President Obama and his Democratic allies make this case for so-called change:
"Americans are spending far too much for health care. That is because of waste and inefficiency among our health care providers. At the same time there are 45 million Americans without health insurance. Your government needs to wring the waste and inefficiency out of the system, curb unnecessary procedures and expenditures, promote behavioral changes to prevent illness, and use the savings to insure and where necessary subsidize the presently uninsured to. achieve universal coverage."
The straightforward way to achieve this lofty goal is to install, as Great Britain and Canada have, a single payer system. Obama says this is what he would do if starting from scratch.
Single payer means that all payments to medical providers for covered health care services are made by one single payer: the government, or one or more administrators contracted by the government. Everyone is included in the system. The funds required by that entity to make payments for services come from taxes.
The government determines which medical services will be covered for which patients, how intensively they will be provided, and how much the providers will be reimbursed for providing those services. The government prohibits any private health insurance coverage for medical conditions covered by the single payer plan.
Single payer systems rely upon the government's global budget to "control costs". The global budget attempts to match expenditures and revenues by directing providers to ration health care through postponement and denial of services, and by reducing government reimbursement to the "private" providers.
Since 1965 the U.S. has had a mandatory single payer system for hospitalization and physician's services for over-65 seniors. It's called Medicare, and it's an inspiration for Obama and his allies. Participation is mandatory, because if you don't agree to accept Medicare, you can't collect your social security retirement checks.