Alan Jacobs, president of Isaac's restaurants, isn't a doctor and doesn't play one on TV.

Yet, because Isaac's offers a health plan to 200 employees, Jacobs finds himself in the position of deciding what physicians they may see, what prescriptions they may take, what hospitals they may use.

"I personally don't think it's right that it's me making the decision," said Jacobs, speaking Saturday at a forum here backing a single-payer health-care system. About 100 attended.

Unfairly derided as socialized medicine, a single-payer system would take health-care finance away from insurance companies and put it in the government's hands. But the government wouldn't run hospitals or make doctors public employees. Rather, it would pay for health care, just as Medicare today pays for the care of the elderly.

Expanding the role of government is rarely popular, which explains why even the front-running Democratic presidential candidates are not calling for a single-payer, Canadian-style health system.

Cutting overhead

But the defects of private insurance — fast-rising premiums, denial of care, loss of coverage between jobs — are starting to convince Americans that creating a new system rather than putting Band-Aids on a dysfunctional one may be the way to go.

A poll of California voters in August found 36 percent want to replace the employer-based system with a state-run system, up from 12 percent in December 2006, according to The Sacramento Bee.

A single-payer plan, advocates say, would be the most cost-effective way to deliver appropriate care in the most appropriate setting to anyone who needs care.

Taxes would increase, but health insurance premiums would disappear. Advocates say most people and employers would come out ahead. Why?

A single-payer system would cut administrative costs, plain and simple. Providers would be paid by one entity, ending the need for staff to seek payment from a myriad of insurers.

Further, it's expected a single-payer agency would have less overhead than insurance companies. Advocates compare Medicare's 3 percent to 6 percent overhead with the 20 percent or more attributed to private insurers.

A single-payer plan also would cover everyone, which means people would be less likely to postpone care until a health problem becomes a catastrophic, costly event.

A single-payer bill in the state Legislature has the support of 37 House members and six senators (none from Lancaster County).

It proposes a tax on Pennsylvania employers of 10 percent of gross payroll, an amount less than what many employers pay to offer workers health insurance. Employees would pay a 3 percent tax on income.

Incremental progress

Don't expect passage any time soon, the bill's prime sponsor, Rep. Kathy Manderino, a Philadelphia Democrat, told advocates at Saturday's forum. Single-payer is too radical for most lawmakers.

That's why she also supports Gov. Ed Rendell's efforts to incrementally control costs and improve access under the existing health care system. She said Rendell's plan represents progress and gets "us halfway to the goal line."

Of course that leaves employers such as Jacobs stuck making difficult choices about their employees' health care.

He said people worry a single-payer plan would result in rationing. "Well, I will tell you I'm providing (rationing) right now" by telling workers "what doctor you can see … what drugs you can take," he said.

"I'm 'The Man,' and I force it on them, whatever I choose," said Jacobs, explaining it's what he has to do to offer a plan Isaac's can afford.

"It's not right, but it's the way it is," he said. "We work with a system that we have, but it is broken."

E-mail: jhawkes@lnpnews.com