Question: What is Single-Payer Healthcare?
Answer: Single-payer health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
Question: Is Single-Payer Healthcare “Socialized Medicine”?
Answer: No. Under socialized medicine healthcare delivery – hospitals, physicians’ offices, nursing homes, etc. – is public (i.e. government operated). Countries with socialized medicine provide excellent and affordable care, but single payer only refers to public (and universal) health insurance, not healthcare delivery. Providers would continue to be a mix of public and private, such as we have today.
Question: Won’t Single-Payer Lead to Long Wait Times and Rationing of Care?
Answer: No. Every healthcare system has to ration its resources, but in the United States we ration based on ability to pay – leaving millions outside of the system – while single-payer systems ration based on medical need. As a profit-driven system, the United States does have problems with wait times for unprofitable forms of care such as primary care, mental health, and even emergency care, while it performs better on income-generating forms of care such as specialty procedures and oncology. Most countries with single-payer do not have wait time problems for any category of care (Commonwealth Fund, 2014), but Canada and England for example have had wait time problems for elective procedures and imaging services due to underfunding of equipment and specialists – particularly when conservative governments have been elected and slashed healthcare budgets. The United States spends two to three times what these countries spend on healthcare per person, and would not experience shortages by switching to a single-payer system.
Question: I Have Good Health Benefits Through My Work, Why Would I Want Single-Payer Reform?
Answer: Many with excellent workplace health insurance have found through a serious illness or injury that their insurance is not excellent after all; moreover, it may cause them to lose their job, and subsequently their health insurance. Furthermore, employers pay the full cost of health insurance out of reduced wages, and health care costs are devastating municipal, state, and federal budgets, cutting into vital public services like education and infrastructure. Single-payer reform means health security that cannot be taken away by misfortune; savings for households, employers and government; and the ability to control cost growth into the future.
Question: Will This Put The Government Between Me and My Health Care Provider?
Answer: No. Currently private corporations – health insurers – stand between you and your care providers, determining which physicians and hospitals you are allowed to see, imposing deductibles and co-payments that often make appropriate treatments impossible, and refusing to pay for care that your providers deem necessary. Under a single-payer system every resident would have full choice of provider, we could eliminate cost barriers to recommended care, and the only oversight for determining what care is appropriate would be provided by medical experts overseeing their peers – not the government.
Question: Would Single-Payer Drive Up My Taxes?
Answer: Single-payer would replace high, unpredictable costs with lower, stable taxes. Unless you are among the top 5% of income earners, a single-payer system is expected to reduce your total healthcare costs.
Question: Won’t Single-Payer be too expensive?
Answer: No, single payer will actually save money by slashing wasteful bureaucracy and adopting proven-effective cost controls like fee schedules, global budgets for hospitals, and negotiating drug prices with pharmaceutical companies. Administrative overhead (also known as “transaction costs”) consumes one-third of current health spending in the U.S., a much higher share than in Canada or other nations. The projected savings from decreased administrative costs are more than enough to cover all the uninsured. It turns out that it is much more expensive to keep patients away from health care in our current fragmented, market-based system than to provide care to all under an administratively simple single payer system.
Question: Won’t Single-Payer just be another bureaucracy?
Answer: The United States has the most bureaucratic health care system in the world. Over 31% of every health care dollar goes to paperwork, overhead, CEO salaries, profits, etc. Because the U.S. does not have a unified system that serves everyone, and instead has thousands of different insurance plans, each with its own marketing, paperwork, enrollment, premiums, and rules and regulations, our insurance system is both extremely complex and fragmented.
The Medicare program operates with just 3% overhead, compared to 15% to 25% overhead at a typical HMO. Provincial single-payer plans in Canada have an overhead of about 1%. It is not necessary to have a huge bureaucracy to decide who gets care and who doesn’t when everyone is covered and has the same comprehensive benefits. 100 million Americans are covered by Medicare, Medicaid, or CHIP, which are all run by CMS, which has only 4000 employees.
Question: What about medical research?
Answer: Much current medical research is publicly financed through the National Institutes of Health. Under a universal health care system this would continue. For example, a great deal of basic drug research, for example, is funded by the government. Drug companies are invited in for the later stages of “product development,” the formulation and marketing of new drugs. Medical research does not disappear under universal health care system. Many famous discoveries have been made in countries with national health care systems.
It is also important to note that studies show that, in the U.S., the number of clinical research grants declines in areas of high HMO penetration. This suggests that managed care increasingly threatens clinical research. Another study surveyed medical school faculty and found that it was more difficult to do research in areas where high HMO penetration has enforced a more business-oriented approach to health care.
Question: Why are copays eliminated? Won’t people abuse this?
Answer: Several studies have found that introducing copays actually increases health care costs as people spend more time in the hospital, possibly because they forego preventative care.