Every plan for health-care-for-all should be analyzed for the out-of-pocket costs each group would be required to contribute, particularly families, workers and small businesses.  At a minimum, any reform package should be clear in what is expected of individuals and small businesses to contribute to a system of universal coverage, as a percentage of income and payroll. 

Single-payer system models for reform are perhaps the "gold standard." Physicians for a National Health Plan has reported that under a national single-payer system, individuals could expect to pay 2% of their income into the system and employers about 7% of payroll.  These amounts are significantly less than what is currently spent.

Single-payer systems ensure all residents have access to health care and significantly reduce administrative and billing costs through a single portal for the administration of coverage and payments to providers for services.  Importantly, single-payer systems combine all money currently being spent in a relatively uncoordinated way into a single pool - individual, employer and government expenses.  There are single-payer movements in numerous states, including Illinois, New Mexico, Pennsylvania, Washington, Connecticut and California, which has twice passed a single-payer bill only to be vetoed by the Governor. 

While the political hill single-payer must climb is steep, all health care reforms should be judged against the standard set by single payer proposals - comprehensive coverage, maximum out-of-pocket expenses, administrative efficiency and simplicity, and costs limited to a percentage of income.  Many reforms in states are moving in that direction and advocates and legislators are increasingly demanding that half-measures be replaced with comprehensive proposals that meet this standard.