Single Payer

Up to this point we have discussed how the healthcare payment model can be changed so that providers are incentivized to provide better quality care at a reduced cost. Now we are going to talk about a single-payer healthcare system, also known as “Medicare for All”, which will address not so much the question of how the provider is paid, but by whom. It’s important to keep in mind that single-payer healthcare refers to health insurance, not health delivery.

 

Our current healthcare system can be defined as a “multi-payer” system in which multiple private individuals or their employers pay for health insurance with various limits on coverage.24 A single-payer healthcare system, on the other hand, pays for all healthcare-related services through a government-related program. It is seen as a way to achieve several goals, namely universal healthcare (single-payer healthcare is a type of universal healthcare—universal healthcare refers to everyone having access to healthcare, whether it is through government-supplied healthcare that is subsidized or paid for entirely through taxes, OR a mandatory or compulsory health system where everyone is forced to buy healthcare—the ACA here in the U.S., or a hybrid system that contains some of each), improved outcomes, and a reduced economic burden for that healthcare.25 The single-payer healthcare model establishes a single risk pool consisting of the entire population of a geographic or political region. It also establishes one set of rules for the services offered, reimbursement rates, drug prices, and minimum standards for required services. A single-payer model provides all healthcare services, be they doctor, hospital, preventive care, long-term care, mental health, reproductive health, dental, vision, prescription drug and/or medical supplies.

 

A single-payer healthcare system is run by the government and operated as a public service. It is offered to its citizens in an effort to provide universal healthcare. The healthcare payment fund is managed by the government directly or as a publicly owned and regulated organization.

 

Not to be confused with:

 

Multi-payer

Two-tiered

Insurance mandate

 

Single-payer contrasts with other funding mechanisms like 'multi-payer' (multiple public and/or private sources), 'two-tiered' (defined either as a public source with the option to use qualifying private coverage as a substitute, or as a public source for catastrophic care combined with private insurance for common medical care), and 'insurance mandate' (citizens are required to buy private insurance which meets a national standard and is generally subsidized). Some systems combine parts of these four funding mechanisms.26

 

Medicare in the U.S. is a good example of a single-payer healthcare system, but it has some significant restrictions based on age and disabilities which would not exist in a true single-payer model. However, the way the program works for those individuals eligible for Medicare is similar to the way a proposed single-payer healthcare system would work for the general populace of the U.S. Advocates argue that the savings from preventive care, the elimination of hospital billing costs and insurance company overhead, would offset the costs of setting up and running a single-payer system. A 2008 analysis of a single-payer bill by the group Physicians for a National Health Program estimated the immediate savings at $350 billion per year.27 The Commonwealth Fund has stated that a universal health care system in the U.S. would decrease the mortality rate, and the country would save approximately $570 billion/year.28

 

Single-payer in the United States

Pros:

As proposed for the U.S., single-payer healthcare would mean:   -Everyone would receive comprehensive healthcare coverage;   -Premiums would disappear;   -A single streamlined, nonprofit, public payer, funded by modest new taxes based on the ability to pay;   -Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital;   -Employers would be freed from the responsibility of providing healthcare coverage for their employees, and its associated costs and coverage decisions;   -Single-payer healthcare would reduce costs by cutting administrative waste and allowing negotiation of prescription drugs;   -Doctors would regain autonomy over patient care;   -Single-payer would create savings for 95% of the population. Only the top 5% would pay slightly more.

 

Cons:

Detractors argue that a single-payer system in the U.S. would:

  -Increase the size of the government. The government would run the system and would need to expand in order to do this. This would require thousands of people in many new departments of the government. Also, it’s worth noting that the providers of healthcare would essentially become government employees.

  -A single-payer healthcare system could reduce or slow down the development of new medicines, treatment therapies and technologies. The government would be the sole buyer for these products, and therefore able to negotiate huge discounts. Less money for the manufacturers of these products and therapies would mean less money available for research and development.

  -Taxes would need to increase in order to fund the system. And those who don’t use the system would be paying for others who do use it.

  -These types of systems require patients requiring approved, non-emergency (read "elective") surgeries to wait. Sometimes a long time. In the U.K. the goal is to provide these types of surgeries in less than five months. In Canada, the wait time goal is less than eight months.

 

The pros and cons of single payer healthcare show that there is potential with this idea, and based on other country's success with single-payer systems, this could be the future of healthcare in the U.S. But there are some difficult scenarios which would need to be worked out before a transition to a single-payer model could be made.