A press release by State Reps. John Kowalko and Earl Jacques (“State Should Move to Single-Payer”, News Journal, 12/11/12) supporting a single-payer healthcare system for Delaware is intriguing, but it incorrectly assumes the economic world is stagnant. They think the insurance industry exists to extract profit from customers and does not add value to the healthcare delivery system. They think Delaware can simply appropriate this profit for which no service is delivered and solve its economic problems.          The truth is Delaware has failed repeatedly to manage Medicaid, our current in-state healthcare delivery system. The state has hired outside management firms to manage the program, all of whom have routinely failed to deliver a functional product. Now Reps. Kowalko and Jacques, surrogates for those who consider government to be the ideal vehicle for managing social issues, expect us to now believe Delaware is capable of managing a comprehensive single payer State Health Insurance Program efficiently.          In reality, the state cannot provide healthcare to any one without the full cooperation and participation of the Christiana Care Healthcare Systems (CCHS). Delaware cannot dictate reimbursement to the primary entity delivering healthcare to Delawares poor. The state will simply have to pay for all of it.          In the face of dictated single payer reimbursement, a large percentage of healthcare providers in Delaware over the age of 60 will simply go out of business or retire. This will create substantial limits of resources and of course limited access to care. This is otherwise known as "legislated rationing".          Although one can simply believe that everything else will remain static, when you make a substantial change in incentives that will change the way people work. The health care services will not continue to be provided without payment and will instead cease to be available. Replacing medical infrastructure services takes a decade or more after decertification and retirement and cannot be restarted quickly.          In summary, the hypothesis put forward by Reps. Kowalko and Jaques is naive and foolish and is fraught with common misperceptions about healthcare. Their views represent a very simplistic view of the healthcare delivery system. The belief the Delaware government, despite its repeated demonstrated incompetence, can effectively manage a complicated industry without any infrastructure talent is without merit.   Christopher D. Casscells, M.D. Director, Center for Health Care Policy, Caesar Rodney Institute