Economic analysis has repeatedly shown that administrative overhead is far greater for competing private health plans than for a publicly financed single-payer system. Administrative costs are about 31 percent of the healthcare dollar in the U.S., 15 percent in countries with single-payer plans.

Other industrialized countries spend far less per capita than we do on healthcare, provide universal coverage, and their doctors and hospitals spend far less money and time on administration. Public plans do not need to pay for marketing, negotiating with employers, underwriting (techniques for avoiding or charging more for insuring sicker patients), multiple private bureaucracies, reserves or profits.

A single-payer funding system is the only option that can assure quality and access at an affordable cost. We cannot continue an insurance system that profits by denying or avoiding paying for care.

President Obama has proposed banning underwriting by private health insurers (standard benefits and same premiums regardless of health status), and allowing an expanded Medicare-like public plan to compete with private plans. This would remove the perverse incentives of plans to avoid covering the sick, but it would not reduce the excess cost and complexity for both providers and patients in a system of competing plans.

Obama's proposed plan also continues and expands Medicaid, a program so broken that Medicaid patients can no longer find a doctor who will see them.

National polls show most Americans favor a universal national healthcare program, along the lines of "Medicare for All."

Most doctors also favor a single-payer plan, but justifiably fear "Medicare for All" because they have experienced claims processing problems and senseless, burdensome policies with Medicare. Fees are often irrational and inadequate, especially for primary care and "cognitive" specialties that emphasize listening to and thinking about patients and their issues, rather than high-tech procedures.

We have a shortage of primary-care doctors, and few medical students are now willing to enter primary-care careers. Medicare's "Sustainable Growth Rate" formula is slated to slash physician fees by 30 percent over the next five years, so it has become very difficult to find a doctor accepting new Medicare patients.

Medicare D drug coverage is intolerably complex and difficult. Hospitals are being driven into bankruptcy by the uninsured and below-cost reimbursement from Medicare and Medicaid, so they shift as much of their costs as possible onto commercially insured patients. A single-payer "Medicare for All" plan would require serious attention to correcting the flaws in the current Medicare program.

Tom Daschle, the incoming Secretary of Health and Human Services, has proposed creation of a Federal Health Board, analogous to the Federal Reserve Board in the financial arena, charged with developing rational healthcare policies that serve the public interest. This board would be responsible for designing and updating the healthcare fee structure, scope of practice issues, allocating funds for medical training and education, public health and quality improvement programs.

A single-payer program would greatly reduce administrative costs and hassles for doctors and hospitals, and control out-of-pocket medical expenses.

Health coverage would be fully portable and not tied to employment. There would be no fragmentation or denial of care when insurers dispute responsibility for an illness or injury.

Most of medical malpractice costs are tied to current and future healthcare expenses, so if all healthcare were fully covered by a universal system, malpractice costs would be slashed. So would worker's compensation and auto insurance costs. Injured parties would not feel forced to sue for fear their healthcare might not otherwise be covered.

A well-designed universal health plan can contain costs and maintain access and quality by serving patients and the providers of healthcare, instead of industry "middle men."

Dr. Stephen Kemble is a psychiatrist and a member of the Hawai'i Chapter of Physicians for a National Health Plan and an assistant professor at University of Hawai'i's John A. Burns School of Medicine. He wrote this commentary for The Advertiser.