I should add: dreamers about single payer need to worry about the loss of jobs in a transition, too.

These jobs (except from an Oct. 14 Forbes piece "Why Health Insurance is Doomed"),

as little as most of us care about these people, a lot of them, now being paid by all of us one way or another, would end up unemployed with single payer:

A bureaucracy that would make Kafka blush

It’s June 2014, and unfortunately I need back surgery. My back surgeon, having carefully reviewed my MRI, turns me over to his “scheduler,” a full-time employee who spends all day every day on the phone talking to insurance company functionaries (or waiting on hold to speak to them) to get authorization to deliver medical care. This staffing is typical of most medical offices, particularly for specialists, who confront endless forms, prior authorizations, and other manifestations of bureaucracy. And then there are the other people doctors and hospitals have to hire to hound the insurance companies for payment once the care is delivered.

The time spent dealing with insurance intermediaries costs money and aggravates physicians and their patients. As one doctor lamented in a column in The Wall Street Journal, “U.S. doctors spend almost an hour on average each day, and $83,000 a year … with the paperwork of insurance companies.” And for every call coming from a doctor’s office or hospital to an insurance company, there is someone at that insurance company on the other end of the line to process the call.

In 2012, more than 460,000 people were working in the health insurance industry, and employment growth in health insurance is much higher than for the providers of actual health care. Of course, managing all these people is expensive—very expensive. In 2011, the CEO of Blue Shield of California made $4.6 million and the organization’s top 10 executives earned $14 million in total, although of course none of them did any medical research or delivered any care to real patients. The Affordable Care Act mandated that health insurers had to spend at least 80% of their collected premiums on medical care. The very inclusion of that provision implies that at least some health insurers had overhead rates in excess of 20%. All of this seems expensive and wasteful, and it is.

There are other models. Kaiser Permanente, a health care provider that combines both a health insurance plan and care delivery in a single organization, serves more than 9 million members and employs more than 17,000 physicians. Without a separate insurance company intermediary, Kaiser saves money, which it then uses to offer lower health insurance rates. For instance, for 2015, the total cost (Stanford’s portion plus my contributions) of purchasing the Blue Shield-administered plan in which my wife and I participate is 39.7% higher than the cost of getting health insurance through Kaiser Permanente. Although many factors might explain this huge difference in price, the simplification of access and the reduction of administrative overhead is a big part of the story. Kaiser, by being both health plan administrator and care provider, has eliminated the insurance company intermediaries that raise administrative costs.

To be clear, that’s precisely what insurance companies are—intermediaries.

It is not true that many of them could get government jobs with single payer. Or at least, hopefully not! Another huge bureaucracy should not be the result, not much of a future goes that way! Perhaps they could be transitioned to jobs more related to caregiving at the same time the huge boomer generation needs more of it.

Cross-link to related: Aetna CEO Says America Should Have a ‘Debate’ About Single Payer