Value-based Purchasing will not permit a Single Payer System

I think that single payor system is highly unlikely in VBP market for a number of reasons, in no particular order:

• Such a market is the highest characterization of capitalism, which thrives on competition
• "Well care" is the new health care
• Republicans are coming back into power and they will at least try to dismantle some of what has already been built
• Individuals and employers are saving a lot of $$$ by managing their own health plan (whether they are healthier or not remains questionable)
• The scariest reasons: Docs of all types are moving away from traditional payer systems
• Our highest value PHYSICIANS know their worth and are reinventing concierge practice with subscription models, telemedicine, and other innovation- they can/will benefit significantly from this new marketplace
• HIT is becoming more cumbersome for Joe-average Doc to keep up, so he's joining forces with Jane-average Doc
• Providers on the fringe of value are dropping out or realigning their careers in less-rigorous roles
• Variability in regions makes CMS multiplier a prerequisite for establishing shop in rural areas

There are many other reasons that have been well-summarized by others.