Because it also allows for states to experiment with their own single payer plans if they so choose. Right now places like Vermont are finding out that it's more costly and harder to do than they expected. Also, it will provide valuable data. One of the proposals at the time was to extend medicaid and medicare to the the late 40s to 50s crowd (the group just outside of the range) for 10 years and study that data as means of determining costs. From there a single payer plan would be derived. But of course the lobbyists beat that back. Regardless, if all this information from exchanges can be analyzed, then you'll be in a better position to transition to a single payer plan and you would have a better idea of potential costs so you'll know how to ration things (because all healthcare systems partake in rationing).
to be fair, Vermont had no intentions on waiting for the ACA to implement a single payer system….they just needed the committed funding from the government
for anyone interested….
http://www.brookings.edu/blogs/up-f...adian-style-healthcare-work-vermont-sanghavi#
Can Canadian-Style Healthcare Work in America? Vermont Thinks So.
While the Affordable Care Act, or Obamacare, has been criticized by its opposition as “socialized medicine,” it relies heavily on private health insurance. On the other end of the political spectrum is the idea that a government-run single payer system, similar to Canada’s, is the best way to deliver health care. (This is sometimes shorthanded in the U.S. as “Medicare for All.”) However, this system has been believed politically impossible here—until now. In May 2011, Governor Pete Shumlin of Vermont signed into law “An Act Relating To A Universal And Unified Health System,”
House Bill 202 (HB 202), establishing a single payer health care system beginning in 2017. In passing this legislation, Vermont has become a closely watched laboratory for health reform.
What are the pros and cons of a “single-payer” system?
In general, single payer health care means that all medical bills are paid out of a single government-run pool of money. Under this system, all providers are paid at the same rate, and citizens receive the same health benefits, regardless of their ability to pay.
There are a number of proposed benefits to a single payer system. Currently, providers must follow different procedures with each of many insurance companies to get paid, creating an enormous amount of administrative work. Under a single payer system, providers might reap significant savings from reduced administrative expenses, and be able to focus more on delivering care. As with Medicare, a single payer system may also give the state stronger leverage to negotiate lower rates for drugs, medical devices, payments to providers and other expenses, resulting in lower overall costs. Additionally, a single payer system provides universal access to health insurance, which eliminates the problem of the uninsured.
However, Vermont’s innovative proposal still leaves room for further improvement. Specifically, a single payer system alone does not address “fee-for-service” reimbursement for providers, which may encourage overuse and does not recognize quality and value. Other concerns also exist. Generally, private insurance rates have been substantially higher than Medicare rates, and providers worry that universal rate setting may lead to overall lower revenues. Others have worried that Vermont does not have enough doctors, and an influx of newly insured citizens may result in longer wait times and inability to access health care when necessary.
