If you think about it, every person in America can get health care, whether or not they can pay for it. The problem is that because of our inefficient system of payment, many, if not most, get the most expensive care, many more get inadequate or postponed care, and still more live in a state of anxiety about their ability to maintain their health. Emergency rooms are all the health care delivery system many people know, and insurance companies make decisions doctors used to make. The many-headed Hydra of health care reform has frustrated presidents, but I am anxious for the opportunity to take it on.

My first big trial involved trying to defend Jimmy Carter’s health care reforms. We lost, though he tried to do the right thing. The policy issues can be complicated, but because I have wandered this particular forest these many years, I have reached the point of embracing simplicity in regards to reform. If we start with a desire to rationalize the payment system, restore the provider/patient relationship, and preserve the high quality of care that makes ours the best in the world, we cannot fail but reach the conclusion that an American variation on the single-payer concept will give us universal coverage, quality care, cost control, wellness and health maintenance, and will leave no patient behind.

The Johnson administration’s health care reforms gave us two single-payer systems: Medicare and Medicaid. Since that time, instead of moving in the direction of a comprehensive single-payer plan, we resort to patches and programs, each with separate administrative regimes, each with distinct eligibility requirements. We all watch helplessly as the costs skyrocket while becoming a drag on our economy and a tax on our competitiveness. Even providers have become disconnected from decision-making. Insanity, it is said, lies in doing the same thing the same way and expecting a different result. Our sanest response is recognizing that even more add-ons to the current dysfunctional construct will not solve our health care dilemma or begin our recovery.

I propose that we transition to a single-payer system to rationalize the insurance aspect and that we shift payment from the employment base on which it now depends to the income tax. By so doing, the immediate payroll adjustment gives working people tax relief where it matters, gives our export sector a competitive boost and deflates the balloon of shifting costs. The General Accounting Office notes that the overhead cost savings alone could amount to as much as 10 percent of total costs. Such a system could in its entirety be funded out of the 14 percent of gross domestic product we currently pay for our inefficient Rube Goldberg of a system.

There is a joke that organized medicine fled the embrace of socialized medicine only to run into the clutches of the venture capitalists. Physicians cannot be happy with the state of the profession to which they have dedicated their lives.

Patients are rarely happy with the system on which their lives depend. If we come together to restore that relationship, to pay for care directly, to allow the insurance function to reimburse, not rule the process, we can finally reach the goal of universal, quality health care for all.

Former Illinois Sen. Carol Moseley Braun is a candidate for the Democratic presidential nomination.