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Kerry Drake, CEO of Wright & Percy Insurance, is afraid the Obama administration’s plan to reform health care is unhealthy not only for his industry but also the country.

A major aspect of the firm’s business is helping employers sort through health insurance options and deal with claims and administrative issues. A scenario in which the federal government completely takes over health care, and his firm’s services are no longer required, would be very bleak from Drake’s perspective.

In short, it would be devastating for the industry. And while President Barack Obama has repeatedly said he rejects a British-style, single-payer government system and that no specific legislation has been put forward, Drake believes the final result—no matter what officials say—is going to be exactly that type of system.

“The end game is a single-payer system,” he says. “My biggest concern is nobody really knows that.”

How could this happen? Through the back door, Drake says. The drive to reform health care is fundamentally about increasing access to insurance for Americans. Drake thinks Congress, under the guise of offering a choice, will create a government-run public insurance plan to be offered through employers alongside private insurance plans that currently are offered through employers.

The public plan—perhaps an expansion of Medicare and Medicaid—will be significantly cheaper than private plans, however, creating a slide in the direction of the government program, Drake believes. Younger employees might tend to flock toward the public plan, leaving older and possibly less healthy employees with their private plans.

“It’s going to create this adverse selection, and over time everybody will be on the public plan,” Drake says. “They want a single-payer system. Now they’re not going to publicly say that, but it will become a single-payer system. I don’t know how many people want a 100% government-run health plan.”

The result of such an uneven playing field will be rationed and restricted access to health care, he says. It’s not an inevitable future, though it’s probable the country will have some kind of national health plan by October.

The possibility that Congress could use a legislative process known as “reconciliation” to avoid a Republican filibuster while pushing through health care legislation is worrisome, Drake says.

At the same time, he’s convinced “something needs to be done with health care.” Drake favors “guaranteed issue,” meaning no denials of coverage to people based on pre-existing conditions, something that’s now common.

“If you have guaranteed issue, that means everybody will have 100% access to coverage, either through their employer or through an individual plan,” he says.

Drake also favors government-mandated coverage, which creates incentives for everyone to get insurance either through their employer or an individual plan, and penalties for not doing so. That’s basically what Massachusetts is doing with its plunge into health care reform.

“If you’re going to force coverage,” Drake says, “you’re going to have to do something.”

Gil Dupré, executive director of the Louisiana Association of Health Plans, says nervousness is understandable anytime Washington cooks up sweeping policy changes. But he’s not convinced the government is gunning for a single-payer system, even if there are some congressional members who would do it that way if they had the chance.

“I don’t think were dealing with a situation where we can point to Washington and say they’re definitely trying to implement a nationalized health system and we’ve got to do something right now to stop that,” Dupré says.

While incremental reform over a number of years could be interpreted as moving in the direction of nationalized health care, we’re not at that point yet and it’s not what Washington is proposing so far, he says. Dupré thinks there’s more interest in a public-private partnership, perhaps an expansion of Medicare Advantage, in which private health plans contract with the federal government to provide an alternative type of plan for those who don’t have access to regular insurance for whatever reason.

Butch Passman, executive director of the Louisiana Business Group on Health, thinks a public-plan option is definitely in the works. He says existing public plans like Medicare, by ratcheting down reimbursements on what they pay doctors and hospitals to treat patients, create “cost-shifting”—making up the shortfall charging more to those covered by private insurance.

“I often tell people who swear by Medicare that if Medicare wasn’t able to shift its costs, you wouldn’t be nearly so pleased with it,” Passman says.

He expects fewer benefits, more rationing and more out-of-pocket expenses with the implementation of a government-run health plan. Because the government has such massive leveraging power in provider rate negotiations and contracting compared to private health plans, a public plan would be cheaper to run—placing private plans at a disadvantage, he says.

“That, in fact, creates a hidden tax to the rest of us,” Passman says.

Dr. Roger Smith, chairman of the neurosurgery department at Ochsner Medical Center in New Orleans and president of the Louisiana State Medical Association, says Obama campaigned on the concept of the existing employer-based insurance market to get insurance coverage to more people—though this is subject to debate even among the largest employers.

He doesn’t believe Obama has a single-payer system in mind. That said, establishing a nationwide public insurance program—perhaps by lowering the threshold of Medicare eligibility by 10 years—could potentially be “the most destructive to the insurance industry” among the various ideas being floated, Smith says.

While many physicians nationwide support a single-payer system, LSMS favors a competitive, market-based system, with the realization that some percentage of Americans will have no choice but to have insurance from a government plan. He does see the necessity for some regulation of the insurance industry—something even the industry itself prefers to being forced to compete with a lower-priced public plan.

“What we would hope to see is that all Americans would have health insurance and access to their physicians and hospitals and other providers,” Smith says, “that it would be done in an equitable, fair way of choice for patients and freedom of choice for physicians to practice what they want and not be regulated to the point where medicine suffers.”