The Steward’s Case for Single-Payer
Ending the Chaos Tax
There’s a pattern in American life that’s become impossible to ignore: the systems we rely on extract more from us than they give. Last week, I wrote about the hidden “Cost of Governance”, the way that institutional complexity becomes its own kind of tax. Nowhere is that more visible, more punishing, or more morally indefensible than in healthcare.
Because in America, we don’t just pay for care.
We pay for the right to try to get it.
The Most Expensive Middleman Problem on Earth
The United States has built a healthcare system where the administrative burden routinely eclipses the medical one. Hospitals employ armies of coders and billing specialists. Insurance companies maintain labyrinths of policy rules, tiers, pre-authorizations, and network exclusions. Patients spend hours deciphering Explanation of Benefits statements that explain nothing.
We’ve normalized a world where a hospital visit triggers a small stack of letters and bills from unrelated entities you’ve never heard of. We’ve accepted that even insured people can be thrown into medical bankruptcy because a form wasn’t filed correctly, or because someone’s “network” changed without notice.
This isn’t healthcare.
This is a bureaucratic engine for profit and pain wrapped in a white lab coat.
Complexity Creates Winners and Losers by Design
The cruelty isn’t accidental. Complexity is the most profitable product in American healthcare. Every opaque rule, every paperwork hurdle, every contradictory answer on a customer service line shifts costs from insurers to patients, from institutions to individuals.
And when a nation forces sick people to become part-time bureaucrats, we shouldn’t be surprised when outcomes are worse and costs are higher.
A country cannot call itself advanced if its people have to navigate a maze simply to stay alive.
The Stewardship Solution: One System, One Standard
Stewardship approaches this differently. The goal is to eliminate waste, confusion, and the adversarial relationship between patient and provider.
A single-payer system does exactly that:
One set of rules
One set of forms
One universal network
One predictable process
One system designed to serve people in need, not shareholders
It’s not just about ease of use for individuals, which alone would be transformative. It’s about making our entire society more capable of taking care of one another. When everyone interacts with the same system, families and communities can support each other with shared experience instead of being divided by insurers, networks, and contract fine print. Problems are easier to identify, easier to compare, and easier to fix when they aren’t hidden behind seventeen inscrutable billing structures.
A shared system strengthens social fabric. It empowers neighbors to help neighbors. It makes healthcare navigable instead of isolating.
The Economic Case: Cutting the Chaos Tax
There’s another major beneficiary: employers.
Right now, American businesses of all sizes spend staggering amounts of time and money negotiating with insurance companies, processing contributions and playing the role of salesman and customer service to their employees. Every compensation package and on-boarding packet includes a stack of documents about premiums, deductibles, and in-network providers.
It doesn’t have to be this way.
A single-payer model frees employers from the role of insurance broker. No more annual negotiations. No more “plan shopping.” No more watching good employees leave because their family doctor isn’t covered under the company’s new network.
When businesses no longer carry the administrative weight of healthcare, they can redirect resources into wages, training, recruitment, retention, and actual benefits. They can be free of serving as middlemen in a system that shouldn’t need middlemen.
That’s economic stewardship.
Beyond the Fear: Short-Term Pain, Long-Term Strength
Yes, moving to a single-payer system would require transition. The insurance industry would shrink. Some insurers would reposition into elective care or supplemental products, luxury goods rather than essentials for survival.
But the payoff is enormous:
Families freed from fear-driven financial decisions
Employers freed from massive administrative burden
Doctors freed from fighting insurers instead of treating patients
Communities empowered to help one another navigate a unified system
A healthier population, a more resilient economy, and a more stable society
It is the greatest return on investment America could make in itself.
The Stewardship Perspective
Stewardship is about designing systems that work for the people they’re supposed to serve. It’s about reducing friction. It’s about aligning incentives with public wellbeing. It’s about cutting out waste and ending the moral absurdity of tying care to the ability to survive a paperwork gauntlet.
A single-payer system isn’t radical.
What’s radical is accepting the system we have now.
Healthcare will be the proving ground for whether this nation still believes in its own people, or whether we continue letting complexity function as a quiet form of cruelty.