OBAMACARE VERSUS SINGLE PAYER

Hi Humans,
The question of Obamacare (Federal Government fills in the gap in health insurance for those without private insurance) versus Single Payer (Federal Government provides all health insurance) has become an issue in the Democratic Primary election. Hillary Clinton favors keeping and expanding Obamacare. Bernie Sanders favors doing away with Obamacare and all private health insurance and replacing them with Single Payer for all Americans. The Republicans say they want to destroy Obamacare. Cruz is enough of a radical ideologue to maybe really do it (big surprise for those among his supporters who depend on it). Trump and Kasich speak the Republican mantra about getting rid of Obamacare but in reality would probably change the name, give it some cosmetic watering down, and actually keep it. Now I am just a dog, so I asked Dad who happens to be a physician who worked for 15 years in solo practice in a suburb of Chicago and 32 years in an HMO here in California. During some years of his HMO time, he was the chief of his department and had some exposure to the administrative side of medicine. So this is why he favors Obamacare and Hillarycare over single payer Berniecare.
1. The HMO where Dad works consists of 2 entities, one insurance company and a confederation of medical groups. Although the insurance humans are not all just heartless money crunchers and the physicians are not all complete altruists, in general the job of the insurance company is to balance the books and the job of the medical group confederation is to provide quality care to the patients. So the medical groups are to some extent the ombudsmen for the patients and the insurance company concentrates on the bottom line. Since the insurance company and the medical group confederation are about equal in power, it works out. In the single payer system, the US government would be the insurance company with which the physicians would have to negotiate. The power would no longer be equal. The balance would be tipped in favor of the bottom line unless you had a comparably strong National Medical Group to negotiate with the government. We have not heard anything from Bernie about a National Medial Group. In fact we have not heard any details from Bernie.
2. A big issue in medical insurance today is that physicians and medical groups have to provide evidence of quality of care in addition to cost effectiveness to the entities that pay money for medical care (insurance companies, corporations, pension plans, federal and local governments, etc.). Gone are the days when the payer gave an HMO a sum of money to care for its people and just said, "Do it." The reality is that it is extremely difficult to provide that evidence. So in order to pacify the payers, measures are often dumped on providers as busy work with little relationship to real quality. This is one of the reasons why you can not simply pull medical insurance policy out of a hat. The process involves trying this or that, discarding what does not work, and expanding what does work (in other words incremental change, not revolutionary change).
3. Competition between insurance plans, including the government plan, is good. Single payer means a monopoly for the government plan.
4. One can say that single payer works in other countries. That might or might not apply here. The USA is an innovative country. Maybe whatever happens here will be better than what happens elsewhere. Medical education and technology in the USA are the best in the world. The problem here is in the distribution of payment. Care must be taken to not decrease the quality of what already exists while improving the distribution. Maybe the process will eventually lead to single payer care and maybe not, but single payer should not be a holy grail in itself. The goal is to provide good medical care to all USA humans however it comes about.
So you humans have a lot to think about. By the way, will you ever consider veterinary care in your plans? After all, that applies to us doggies.
Chloe