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Q&A: Is the U.S. Moving Towards Single-payer Healthcare?

Recently, Vermont Sen. Bernie Sanders introduced a “Medicare for All” proposal that would create a single-payer healthcare system in the United States. Swapna Reddy, JD, MPH, clinical assistant professor in Arizona State University’s (ASU’s) College of Health Solutions, explains the benefits and drawbacks of single payer, and how likely it is that the country would adopt such a system. 

What is single-payer healthcare?

When we discuss a single-payer healthcare system, we are referencing a system by which healthcare providers are reimbursed for their services by a single entity—the government—rather than by private insurers. Providers are paid at the same rate and individuals all receive the same health benefits through that system. All members of a society in which a single-payer model exists contribute to a single pool and that pool is meant to cover the health services of all other members, regardless of their finances.

Simply having a single-payer system, however, does not completely remove private insurers from the equation, since Medicare occasionally utilizes private insurers to act as middlemen between providers and the government.

What are pros and cons of this type of system?

The major healthcare systems all have their pros and cons, and the right approach for any one society is a highly nuanced decision that depends on a country’s social contract with its citizens, foundational principles, and relationship with government.

Some pros:

·       Universal coverage

·       Overall healthcare spending will likely be reduced

·       Overall health outcomes will likely increase

·       Rate consistency for services

·       Providers can still offer private services outside of the single-payer system

·       Existing models in Medicare and Medicaid

Some cons:

·       Some providers may choose to provide services only through a private-pay system

·       Does not address provider shortages in the United States

·       Generally includes higher taxation

·       Known to have long wait times for non-emergency services

·       Increases the role of government

·       Reduces incentives for innovation

How likely is it that the United States will adopt a single-payer healthcare model?

With regards to the recent “Medicare for All” bill proposed by Sen. Bernie Sanders, we have seen a dramatic level of support within the Democratic Party in Congress. In the Republican-led Congress and Republican-led White House, however, this bill has a minimal to no chance of passing in the near future. Nevertheless, public support for major provisions of the Affordable Care Act, paired with recent polling, indicates modest increases in the American public’s openness towards this approach. That said, recent polls also indicate that while more of the American public wants increases in coverage and access, less are willing to pay higher taxes to achieve those goals.

So while we are perhaps closer than we’ve ever been, we are still quite a ways away from adopting this system. This remains a highly polarizing issue, and movement either towards single payer or away from it will depend largely on the results of the next presidential election. In the end, the model we adopt will likely be a uniquely American solution.

This article was adapted from information provided by ASU.