This Is How We Can Adopt a Single-Payer Health Care System

There’s one benefit to being the only wealthy country in the world still lacking comprehensive coverage for basic health-care needs of its citizens: It’s not possible to claim ignorance or incredulity over how such a system could be adopted.

After all, the United States is surrounded by examples of effective universal coverage, including Canada, the UK and Japan. Each country provides its populace with health care, though not all in the same way.

Even more limited programs currently in the United States, like Medicare, provide a possible model. But how might each of these work?

Hybrid Public and Private Insurance Market

This is basically the politically popular Medicare-for-All. Medicare and/or Medicaid has the advantage of being an existing model that simply needs to be expanded to reach all demographic groups across the country.

In terms of legislation and building on the infrastructure of the current system, there are some political and practical benefits to pursuing this fairly straightforward approach to health coverage. Since 1965, Medicare has been a government-sponsored insurance program. If there were no limits on who could qualify for it, then anyone lacking health insurance purchased privately or provided through an employer could opt in.

Essentially this insurance option then competes with all the privately paid options. Therefore, this approach doesn’t disrupt the existing system, and people can keep their current insurance.

But one of the big questions is whether this coverage will be superior, inferior or at par in terms of the coverage it provides and the premiums it charges.

If, for example, the program were badly underfunded, then only those with no other options would sign up — though this would still be an improvement given that more than 12 percent of Americans are currently uninsured. Of course, if Medicare coverage is either unaffordable or provides poor coverage, it’s a fairly small improvement.

Meanwhile, if a ton of money were pumped into such a federal program to make it robust and comprehensive, private insurance companies might not be able to compete — which raises the question, why not just go single-payer in the first place?

Single-Payer Insurance

Strictly speaking, single-payer means the government provides 100 percent of its citizens with health insurance, and there are no private health insurance companies. This is Canada’s model — and one that the American group Physicians for a National Health Care Service endorses.

Health care is provided for all citizens, regardless of socioeconomic status, with the bill being footed by all taxpayers. There’s no opting in to a premium plan, but there are also no premium payments or deductibles.

It’s important to note that the Canada Health Act covers everything from regular check-ups to emergency room visits to surgeries, but it doesn’t include dental or vision care — nor most prescription drugs. Drugs given in hospital, like anesthesia, are covered, but those picked up at a pharmacy are paid privately. Private companies, therefore, can offer plans for these kinds of health services, often through employers.

One of the key advantages to single-payer is that it makes the insured pool universal. The ability of private insurance companies to limit coverage by denying those with pre-existing conditions from accessing insurance, for instance, is a way for them to keep pay-outs predictable and profits up. A government-covered universal health insurance plan prevents that outcome, though the supply side of the system remains largely private.

Single-Payer Services

This variation of single-payer has the government not only running the insurance side of things, but also the health care supply side of things. In variations of this approach, public health providers may compete with private health providers or may be the exclusive provider.

The UK’s national health insurance falls under this category, and it involves the government managing expenses in hospitals — including professional staff pay and capital costs. Hospitals are public in the same way that most American schools are public, making doctors a one-step removed type of public servant similar to public school teachers.

Again, a possible advantage here is that neither the hospital nor the insurance provider is trying to make a profit, lowering individual costs. And, of course, the universal pooling means everyone chips in a little and no one loses their house over a medical bill.

Such a system is vulnerable to the kinds of challenges other government entitlement programs, like Social Security, face when costs go up and the government fails to manage the funding adequately through the tax base. But that’s a management issue that could be more easily avoided if, for example, the government stopped giving $10 trillion tax cuts to the rich.

Conclusion

With any kind of single-payer system, the social and economic benefits could be substantial. The current system is very profitable for the few, meaning it contributes to the wealth gap. Any kind of improvement in access to affordable health care, therefore, has the opposite effect. And that means it will make the country economically stronger.

Certainly, there’s no question that it can be done. But if you agree, like most of the developed world, that health care is a right, then that’s actually the only reason that matters.

Photo credit: Getty Images

67 comments

Annabel Bedini
Annabel Bedini20 days ago

Paul B
Sorry, I should have added 'and spheres of influence' to 'economics'.

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Annabel Bedini
Annabel Bedini20 days ago

Paul B
Nobody is saying that the rich can't have access to private health care if they are prepared to pay for it. In all countries that have so-called universal health care there is a flourishing private sector alongside state health care. As Rhoberta E says. So I'm afraid your reasoning doesn't stand up.

As for your comments about America being the world's policeman for everyone's good, well, honestly, you are simply not understanding why the U.S. intervenes militarily in other countries. Believe me it's a choice built on economics not altruism. I'm afraid you do come across as somewhat naive.

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Rhoberta E
Rhoberta E20 days ago

paul b
As USUAL your spin on health care that is "single payer" or Universal" is WRONG !!
Please tell this membership what care is NOT covered in Canada !
The other thing you choose to not share is the fact that all you "rich" US citizens with your VERY expensive delivery of care, is that IF you want to pay for care even here in "socialist" world, you CAN !!
Private insurance coverage is available and cash always works too.
Do your homework paul.

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Paul B
Paul B22 days ago

Annabel, part that was cut off.
They just love to demonize people with wealth while pandering to the less fortunate with promises of more free stuff. The answer is raising the opportunities in society for more people to gain wealth, not take it from others. That is exactly what Trump has done.

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Paul B
Paul B22 days ago

Brian,
Did you know that everytime we have decreased tax rates, revenues to DC have increased substantially. It has worked everytime its tried, so your argument of raising taxes raises revenues is totally backwards. If you want more of something, reduce taxes, if you want less of something, tax it. That is a very simple fact that most Dems fail to realize as they are too busy trying to bring the wealthy down rahter than trying to raise the por to higher standards. It fails every time. We have spent trillions in trying to pay for increases in the poor standard of living, but we have seen no improvement in 50 years. It just doesn't work. The only thing that will turn that tide is to expand the economy so more can prosper. It isn't a fixed pie size that must be divided equally. No, you prow the pie so more can eat well.

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Paul B
Paul B22 days ago

Also Annabel the reason other countries are ab le to dedicate as much resource as they do to healthcare services is that they spend so little on defense. The US is basically the world's police, protecting many countries from the evils in the world. We do it because we know it is the right thing to do, not only for the freedom loving countries, but eventually for ourselves as the spread of evil, left unchecked is an extremely destructive force. I know that is an entirely different discussion, but it does factor in this equation.
Also, many believe that by simply raising taxes we can pay for so much more. They believe that taxing the rich will generate billions in additional revenues to DC, but it never amounts to anywhere near what they assume. The rich, like in any country have ways to avoid the tax increases by buying legislation in DC, through both parties, it makes no difference. So what happens now is the burden, like usual on the middle class which are always the fall class for paying for Dem welfare policies.
Plus, if you took all the wealth of all the richest in the US, it would barely put a dent in the monies that are currently being spent. So few ever really take the time to analyze this fact. They are under an assumption that these rich people have enough wealth to pay for everything the Dems want, but that fact simply isn't true. They just love to demonize people with wealth while pandering to the less fortunate with promises

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Paul B
Paul B22 days ago

Annabel,
Short answer is NO I don't. But, as with any universal healthcare system, there are limitations as to what can be covered. There is NO system in the world that covers EVERY illness for EVERY individual. There must be limits due to limitations on available resources. The system becomes what is best for the WHOLE and less for what is best for the individual.
With that said, private insurance will always be made available for the rich, who can afford to pay for whatever they need, without any government limitations. You see that now in countries where the rich will travel to the US or buy supplemental insurance to cover what the government can't or won't.
So really your question boils down to this. Should people who can afford premium healthcare be denied access to services that the government won't or can't provide, on a timely basis (which is sometimes another issue)? That isn't fair to them either. Single payer healthcare in the end reduces the global delivery of services down to t level where all are equal... it doesn't raise the global standard for care. IT helps some, yes, but it lowers it for others if access to private care is removed which isn't fair either.

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Annabel Bedini
Annabel Bedini26 days ago

Paul B
Yo haven't answered my question so I'll repeat it: You think the rich should have better health care than the poor? If so, why?

Brian F
Of course I agree with you! Particularly about Republicans not understanding what 'socialism' means, they seem to equate it with communism.

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Brian F
Brian F27 days ago

Annabel Bedini Paul B is a Republican and like most Americans doesn't understand socialism. Paul B doesn't understand that our healthcare system is nefarious because our greedy health insurance industry runs it and only cares about money, and profit. Paul B fails to understand that if we pay higher taxes like they do in many socialist countries, we can have better healthcare, free colleges, a cleaner enviroment, and so on. We had higher taxes for 50 years after our Depression 1930's, and the economy thrived. Like all Republicans and many corporate Democrats, Paul B lives in a fantasy land, and thinks lowering taxes for the rich is good, when it is not. Paul B like so many fail to see that if we extend Medicare, which currently covers everyone over 65, to cover everyone, we can get the criminal health insurance industry out of our healthcare, and lower cost, and improve hralthcare for everyone. This is why we need Medicare for all as proposed by Bernie Sanders.

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Carol Johnson
Carol Johnson27 days ago

Thanks for sharing

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