Certainly a transition of some sort would be necessary.
The issue I have is that, as I understand it, the selling point of single-payer over more incremental (some would say realistic) options is that it's
disruptive--it has a bigger impact faster. We have big savings from slashing administrative costs and streamlining things, we immediately start to push health care prices downward through price-setting, whatever.
Those are huge things! Lots of people would find themselves out of a job, some providers wouldn't be able to keep their doors open. Health care is a major employer everywhere. In some places it's
the employer (see
The Largest Employer in Every State from this month: "
In 14 states, a health care network is the largest employer, including Partners HealthCare in Massachusetts, which employs 68,000 people. Several of these health care networks are also part of a university system, such as the University of Pennsylvania Medical Center, which employs 61,000 people in the state.") You suck money out of that industry overnight, as some single-payer advocates promise to do, and there will be major repercussions.
That's why this is hard. And when you press people on this, they dial down the disruption. They begin to downplay the layoffs and the pay cuts and the savings.
But the disruption is one of the points of the whole thing! If you take the edge off the disruption, you're reducing the impact of the change and undermining the rationale for doing something so drastic in the first place. And the unwillingness of even the zealots to own the intended impacts, much less embrace them, should be a major red flag for the feasibility of the whole thing.