The Single Payer Debate: 163 hurdles to overcome in Texas alone.

As I've noted before, one of the biggest hurdles to overcome when considering moving to Single Payer healthcare is that at least a half a million people currently work directly for health insurance carriers, plus (I'm guessing) another couple million in directly related services. While I do support moving to SP eventually, any plan which replaces the current private insurance industry would have to also take into account what would happen to those people.

To illustrate this, at the bottom of this post is a full list of every company which offered private health insurance policies in the state of Texas as of 2014. Note that some of these are really just divisions of a parent corporation (Aetna Health/Aetna Life, etc), and many of them didn't happen to have anyone actually enrolled in health insurance policies that year, but the point is that moving to single payer (again, assuming that included replacing all private policies for everyone and assuming that it would be a comprehensive policy which didn't leave room for supplemental coverage) would mean that every one of these companies would go out of business...or at least shut down a major division of their operations in the cases of companies which also sell life/auto/homeowners/etc.

Again, in the long run I have no problem with this whatsoever. I have no animus towards any particular insurance carrier, but I also see the very concept of profit-based health insurance as troubling and unnecessary. At the same time, however, these are real people working for real companies, and very few of them are the Fat Cat Multi-Million Dollar CEOs that we all despise.

If the idea is that the federal government would hire these 500,000 people (that's nationally; I assume it's more like 50K or so in Texas specifically) to handle the government-run equivalent of their current job, that's fine, but we'd better make sure to take that into consideration. What happens to multi-year legal contracts between these companies and the healthcare providers? What's the economic impact of 160 companies being shut down in one state alone? How much transition time would be needed to do all of this? Then multiply that by 50.

Again, none of this has anything to do with either the political realities or even whether moving to comprehensive SP would be more cost-effective/less expensive in and of itself; it's about the sheer logistics and real-world impact making the move would have.

I cannot stress this enough: In the long term, I'm 100% supportive of this happening...but I simply see no way of it happening over the course of a few years even if all of the political and economic winds were all lined up perfectly for that entire period of time.

• 4 Ever Life Ins Co
• Accendo Ins Co
• Ace Prop & Cas Ins Co
• Aetna Hlth Inc TX Corp
• Aetna Hlth Ins Co
• Aetna Life Ins Co
• All Savers Ins Co
• Allegian Ins Co
• Allianz Life Ins Co Of N Amer
• American Alt Ins Corp
• American Benefit Life Ins Co
• American Fin Security Life Ins Co
• American Gen Life Ins Co
• American Heritage Life Ins Co
• American Natl Ins Co
• American Natl Life Ins Co Of TX
• American Specialty Hlth Ins Co
• Amex Assur Co
• Assurity Life Ins Co
• Athene Ann & Life Co
• Athene Annuity & Life Assur Co
• AXA Equitable Life Ins Co
• Axis Ins Co
• BCS Ins Co
• Best Life & Hlth Ins Co
• Celtic Ins Co
• Central United Life Ins Co
• Chesapeake Life Ins Co
• CICA Life Ins Co of Amer
• Cigna Hlth & Life Ins Co
• Cigna Hlthcare of TX Inc
• Citizens Natl Life Ins Co
• Commercial Travelers Mut Ins Co
• Community First Grp Hospital Serv Co
• Community First Hlth Plans Inc
• Community Hlth Choice Inc
• Companion Life Ins Co
• Connecticut Gen Life Ins Co
• Consolidated Ins Assoc
• Constitution Life Ins Co
• Continental Cas Co
• Coventry Hlth & Life Ins Co
• Coventry Hlth Care of TX Inc
• Delaware Amer Life Ins Co
• Enterprise Life Ins Co
• Federated Mut Ins Co
• Fidelity Life Assn A Legal Reserve L
• First Allmerica Fin Life Ins Co
• First Continental Life & Acc
• Freedom Life Ins Co Of Amer
• General Amer Life Ins Co
• GHS Ins Co
• Golden Rule Ins Co
• Guarantee Trust Life Ins Co
• Guaranty Income Life Ins Co
• Guardian Life Ins Co Of Amer
• HCSC Ins Serv Co
• Health Care Serv Corp A Mut Legal Re
• Health Net Life Ins Co
• Healthspring Life & Hlth Ins Co Inc
• HM Life Ins Co
• Humana Benefit Plan of IL Inc
• Humana Hlth Plan Inc
• Humana Hlth Plan of TX Inc
• Humana Ins Co
• Idealife Ins Co
• Illinois Mut Life Ins Co
• Independence Amer Ins Co
• Insurance Co of Scott & White
• Integon Natl Ins Co
• Jefferson Life Ins Co
• John Alden Life Ins Co
• Kanawha Ins Co
• Kilpatrick Life Ins Co
• Knights Of Columbus
• KS Plan Administrators LLC
• Leaders Life Ins Co
• Life of Amer Ins Co
• LifeSecure Ins Co
• LifeShield Natl Ins Co
• Loyal Amer Life Ins Co
• Madison Natl Life Ins Co Inc
• Mamsi Life & Hlth Ins Co
• Massachusetts Mut Life Ins Co
• Memorial Hermann Hlth Ins Co
• Metlife Ins Co USA
• Metropolitan Life Ins Co
• Mid West Natl Life Ins Co Of TN
• MNM 1997 Inc
• Molina Hlthcare of TX Inc
• National Benefit Life Ins Co
• National Family Care Life Ins Co
• National Found Life Ins Co
• National Guardian Life Ins Co
• National Hlth Ins Co
• National Security Ins Co
• National Union Fire Ins Co Of Pitts
• Nationwide Life Ins Co
• New England Life Ins Co
• New Era Life Ins Co
• New Era Life Ins Co Of Midwest
• New York Life Ins Co
• Nippon Life Ins Co Of Amer
• North Amer Ins Co
• North Carolina Mut Life Ins Co
• Ozark Natl Life Ins Co
• Pacificare Life & Hlth Ins Co
• Parkland Comm Hlth Plan Inc
• Pennsylvania Life Ins Co
• Philadelphia Amer Life Ins Co
• Physicians Mut Ins Co
• Primerica Life Ins Co
• Protective Life Ins Co
• Puritan Life Ins Co
• Puritan Life Ins Co of Amer
• Pyramid Life Ins Co
• QBE Ins Corp
• Regal Life Of Amer Ins Co
• Reliance Standard Life Ins Co
• Reserve Natl Ins Co
• Safeguard Hlth Plans Inc
• Safehealth Life Ins Co
• Scott & White Hlth Plan
• Sendero Hlth Plans Inc
• Seton Hlth Plan Inc
• SHA LLC
• Shenandoah Life Ins Co
• Sierra Hlth & Life Ins Co Inc
• SilverScript Ins Co
• Southwest Life & Hlth Ins Co
• Southwest Serv Life Ins Co
• SPJST
• Standard Life & Accident Ins Co
• Standard Life & Cas Ins Co
• Standard Security Life Ins Co Of NY
• Starr Ind & Liab Co
• State Farm Mut Auto Ins Co
• State Mut Ins Co
• Sterling Investors Life Ins Co
• Sterling Life Ins Co
• Superior Hlthplan Inc
• Time Ins Co
• Transamerica Premier Life Ins Co
• Trustmark Life Ins Co
• Unicare Life & Hlth Ins Co
• Unified Life Ins Co
• Unimerica Ins Co
• Union Labor Life Ins Co
• Union Security Ins Co
• United Amer Ins Co
• United States Fire Ins Co
• United States Life Ins Co in the Cit
• United Teacher Assoc Ins Co
• UnitedHealthCare Benefits of TX Inc
• UnitedHealthcare Ins Co
• UnitedHealthcare Life Ins Co
• UnitedHealthcare of TX Inc
• US Hlth & Life Ins Co Inc
• USAble Life
• USAble Mut Ins Co
• Vision Serv Plan Ins Co
• Wellcare of TX Inc
• West Coast Life Ins Co

You want more? Here's a list of the 308 Accident & Health insurance companies operating in Wisconsin, also as of 2014 (in this case they don't separate out health insurance specifically, and many of the multi-state companies are the same ones as the Texas list, so the WI number is probably much lower than 308, but that's besides the point).

Multiply this by all 50 states and you're probably talking about a good 5,000 or so companies. Many of them have non-health divisions and would carry on, but others only sell health insurance (or health may make up 80% of their earnings). Again, in theory I'd shed no tears for them being placed on the scrapheap, but in practice, pulling the plug on them would have to be done in a very carefully thought-out way, and the people working for those companies may not be too keen about having their job killed "for the greater good", etc etc.