Call to Action: Single-Payer Healthcare

Healthcare is perhaps one of the most politically charged issues affecting the United States. It is also probably one of the most misunderstood. In some political circles, terms like “universal” or “single-payer” medicine are rejected. However, the Pew Research Center found that more than 50 percent of Americans support single-payer care—the highest share in more than a decade. Other studies suggest that investing in universal health coverage would cost less—saving the U.S. roughly $2 trillion between 2022 and 2031—and boost the economy.

While single-payer medicine remains a controversial issue, here is a closer look at how it works, including its myths and merits.

Single-payer healthcare, universal healthcare, “Medicare for all”—these are the words we use to discuss health systems in America. They are diverse and, often, politically charged. We also tend to lump different types of systems into a single category, such as calling healthcare in the United Kingdom and Canada “socialized” medicine or “universal” healthcare when there are distinct differences between the systems. Here is a breakdown of the popular types of healthcare programs and some of the common myths associated with them.

Universal healthcare commonly refers to comprehensive coverage, meaning all citizens in a country have access to basic care. This is only half the story. When experts use the term, they typically involve a system in which the national government manages medical care and funding. In other words, doctors are government employees, and costs and practices are standardized across the state, province, or nation. Another common term for this type of system is socialized medicine.

• Myth: Universal medicine is a limited system. Citizens living in countries with universal medicine are not necessarily limited to public care. Many nations have a supplemental private insurance industry, though the national government tightly regulates it. As the New York Times reports, in countries like France, the U.K., and Canada, the government pays for about 80 percent of health costs while patients or employers pay the remaining 20 percent with supplemental coverage.
• Countries with universal care: Australia, Switzerland, and the United Kingdom

Like universal medicine, single-payer healthcare provides comprehensive coverage for all citizens. The difference is that the government administers and regulates health costs in a single-payer system. Also, providers are private. Doctors are not government employees. Proponents of single-payer medicine note that such a system cuts back on administrative costs and allows the government to negotiate for better contracts. When someone discusses “Medicare for all,” they often mean a single-payer system.

• Myth: Single-payer medicine is a government takeover. As noted above, single-payer systems allow governments to regulate health costs and payments, but most care remains private. This is precisely how Medicare works: Medicare recipients do not have to go to government-run hospitals or offices. As with universal care, many single-payer countries allow citizens to obtain private, supplemental coverage. In Canada, for example, the government pays about 70 percent of health costs and private employers frequently offer additional plans—including vision and dental coverage—as an employee incentive.
• Countries with single-payer care: Canada, Denmark, and Sweden

Multi-payer health usually refers to a system that offers universal coverage through “sickness funds,” which may be public, private, or nonprofit despite strict government regulation. According to the American Bar Association, multi-payer health systems allow individuals to choose between insurance companies that administer payments, though prices are generally set at a national level.

• Myth: The U.S. has a multi-payer system. Some people conflate the country’s private health system with a multi-payer system because care and costs are privately managed. What distinguishes multi-payer health, however, is that it is much more tightly regulated and it ensures a basic level of care for all citizens regardless of employment status. In countries like Germany, individuals and employers may invest in coverage beyond this basic minimum, for private dental and vision care, or additional prescription coverage.
• Countries with multi-payer health systems: Germany, Japan, and France

The United States is home to some of the best physicians in the world, cutting-edge research, and comparatively short wait times for primary care, yet its health systems repeatedly rank among the worst industrialized nations for overall coverage and care. In a nutshell, the problem is that we spend the most but have inadequate overall access to care and relatively poor outcomes. Let’s review the numbers.

According to a 2017 report from the global Organization for Economic Cooperation and Development, Americans spend the most per capita on medical care than any other nation. Their healthcare costs are the highest in the industrialized world, and they pay the highest share of out-of-pocket expenditures than any other country.

According to the OECD study, population coverage for a core system of health services in the United States is the second-worst of all industrialized nations analyzed. About one in five Americans skip medical consultations or prescribed medication due to cost, and life expectancy for U.S. newborns is below the world average. The country reports higher-than-average avoidable hospital admissions, meaning visits that could have been avoided with proper primary and preventive care. And what’s more, there is a massive gap in life expectancy among groups of different socioeconomic circumstances, including race, income, and level of education.

Experts cite many reasons for the nation’s comparatively poor health system performance. The U.S. healthcare is a complicated network of private, government and multi-payer care. This financial structure fuels high administrative costs. Meanwhile, the mostly private system means that the government is unable to regulate fees or negotiate expenses on citizens’ behalf. The private competition also drives up marketing—and therefore coverage—costs. Experts suggest that advertising fees account for about 15 percent of total private health insurance premiums.

• Myth: Innovation drives up health costs. Opponents of universal healthcare frequently link high insurance costs with the nation’s robust medical research community. While it is true that the U.S. is a global leader in health innovation and that research is expensive, Bloomberg reports that these investments do not account for the nation’s inflated health costs, and certainly not for its relatively weak care outcomes.

The case for single-payer care—as reported by the Brookings Institute, the World Health Organization, Harvard Politics, Harvard Public Health Review, and others—is strong. Single-payer care can benefit workers, employers, and the government alike. Perhaps the most significant benefit of passing single-payer health in the United States is the universal coverage it would provide.

For the first time, Americans would have access to proper primary medical care regardless of employment status or income. This would also minimize some of the gaps in accessibility and equity among various social groups—though wealthier Americans could access better care through supplemental, private plans. What’s more, investing in a healthier workforce would spark a boom in the U.S. economy and may even boost innovation. According to the Harvard Business Review, workers are more likely to pursue their ideas and start a business if they do not fear to lose their employer-provided coverage.

Another critical benefit of single-payer healthcare is simply that it is less expensive. Government regulated and negotiated medical plans can significantly reduce administrative and marketing costs associated with private care and cap costs at the state and federal level.

Employers could still offer supplemental policies as employee incentives, but much of the money they currently put toward private plans would go to the government instead. This is important to note as several opponents of universal care suggest switching to single-payer care would be astronomically expensive when, according to researchers, overall healthcare costs would go down by $2 trillion over the next several years. Government costs would go up as it assumes the responsibility for care, but savings and additional revenues would more than offset them.

Adopting a single-payer health system in the United States would be a tremendous undertaking, but research suggests it is a worthy one. Nonetheless, in the New England Journal of Medicine, Dr. Jonathan Oberlander indicates that political interests and lobbying groups would make it difficult to achieve the Senate supermajority required to pass such a bill, even if it would save Americans money in the long run. It is up to voters to educate themselves on the ins and outs of health finance and the healthcare industry so that they can carry that knowledge to the ballot.

To learn more about how to get involved in the push for single-payer health, check out the following groups:

• Universal Healthcare Action Network (UHCAN)
• Healthcare Now
• Campaign for Better Healthcare
• Families USA
• Physicians for a National Health Program
• National Coalition on Healthcare
• American Medical Student Association
• National Physicians Alliance
• Healthcare for America Now

Aimee Hosler

Writer

Aimee Hosler is a long-time journalist specializing in education and technology. She is an advocate for experiential learning among all ages and serves as the director of communications for a non-profit community makerspace. She holds a degree in journalism from California Polytechnic State University in San Luis Obispo.