And seniors tend to be quite happy with it. There are downsides to single payer, but if we expanded the risk pool to include healthy young people, cut the need to purchase 65 years of private insurance before we get old and become regular consumers of healthcare, and made Medicare apply cradle to grave (which would also eliminate the need for Medicaid) there is no doubt (NONE) our system would be markedly more cost-efficient. Everyone would love it but the healthcare and drug providers who now have license to rip everyone off and pass their costs onto middle men who pass their expenses on to consumers.

Whether that would negatively affect quality of care is questionable (it probably would for some but would do the opposite for others and decrease costs for everyone) and I'm not sold that it's the best system around (I'd probably go with France's system although that's just based on what I've read and I'm sure there are others that have far more informed opinions). But there is again no doubt our patchwork, quasi-single-payer system is about as cost inefficient as a system could be, even after O-care improving it a great deal.