A single payer health care system refers to a system in which the government takes sole responsibility for paying, administering and providing all health services in its territory. This differs from our current system where various sectors finance healthcare coverage through private providers while federal and many state governments finance some. Despite recent interest in healthcare reform, many Americans remain confused as to what a single-payer health care system entails and how it would operate; this article is meant to demystify this concept and show how a single payer system would differ from our current health insurance market.
Numerous proposals exist across the nation to establish single-payer healthcare systems. These proposals range from national to state levels, some seeking universal coverage while others focus purely on cost containment. Most of these proposals aim to overhaul financing, pooling, purchasing and delivery of healthcare services to improve outcomes while at the same time realizing savings via reduced premiums or administrative costs for private insurers – not to mention reduced healthcare expenditures.
“Single-payer” is an indistinct term with multiple interpretations, leading to differing definitions across countries and systems. But what unifies most single-payer health care systems around the world is their focus on covering all citizens through public plans – something the Affordable Care Act (ACA) has made progress towards, but 29 million Americans still lack coverage and many others struggle with rising copays, deductibles, and out-of-pocket expenses that threaten access to high quality healthcare. A truly single-payer system would eliminate all financial barriers and ensure all have access to high quality healthcare for everyone involved – something the ACA made considerable headway on.
Although several states (e.g. Vermont) have explored single-payer systems, passage of legislation remains difficult due to their enormous costs and impact on other government spending priorities. A recent report by the Congressional Budget Office (CBO) examined various single-payer models that would create universal health coverage; they all involved significant increases or new taxes or taxes increases, reductions or savings elsewhere or borrowing from the public at significant rates.
Senator Bernie Sanders’ Medicare for All plan endorsed in his 2016 presidential campaign offers one solution, expanding existing programs rather than creating one from scratch. But this approach may not fully address cost issues and require more fundamental change to how health care financing is accomplished.
No matter its exact design, any plan to establish a single-payer system must be clear and comprehensive. It should outline how such a model could reduce costs while improving access to affordable, quality healthcare for patients and empowering patients to demand value from providers. Without such transparency it will likely never come about; without it the healthcare debate won’t ever end up resolved.