Health-care costs, moreover, would be reduced. Unlike HMOs, which eat up to 35 percent of their revenue with administrative overhead, advertising and profits, single-payer systems such as Medicare or the Canadian health system direct 97 to 98 cents of every dollar to health-care delivery. With the clout to buy drugs in bulk, the state could slow the rising cost of medicine. Because everyone would be eligible for primary care, people would reduce their use of costly emergency-room services for minor health problems. Doctors and hospitals would also be freed from the paperwork that now consumes so much of their time.

A single-payer plan could also make California businesses more competitive. When the costs and risks for health care are spread across an entire population, rather than just among those who have employer-paid health benefits, health care costs are reduced. When everyone pays a small payroll tax, responsible employers no longer face the competitive disadvantage of shouldering the cost of providing health insurance for their own individual workers. Negotiations between labor and management, moreover, are dramatically changed because health care is off the table.

In my view, a single-payer plan is clearly preferable. But the concept is confusing for many people at first. One reader, for example, wrote that he "doesn't want government involved in health care, since it would never work as well as Medicare."

What this man doesn't realize is that government already administers universal health coverage for the elderly (Medicare) and universal health care access for low-income children (CHIP). It's the rest of us who fall between the cracks.