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What is Single Payer Health Care?

The current system of health care in the United States involves multiple parties who pay health care providers through intermediaries (namely health insurance companies) with private and/or public funds. Therefore, it's what you might call a "multi-payer" health care system.

Each payer -- whether it's an employer, an individual, or some other entity -- has certain limits on coverage, depending on the insurance company and/or the plan. All insurance plans are subject to certain laws, such as protections against certain forms of discrimination.

But if the status quo is a multi-payer system, then what is "single-payer" health care? As the name implies, with this approach a single entity pays for health care services; but this isn't necessarily a "government-run" system. We'll discuss the details below.

Single-Payer Health Care and Medicare for All

The prospect of a single-payer system in the United States is often referred to as "Medicare for all," which is a fairly apt description. Like Medicare, the government is the single payer of services, replacing insurance companies, but these services would continue to be provided by a combination of private and public entities.

In the current system, for-profit and not-for-profit health insurance companies offer a wide range of plans at different rates, as regulated by the Affordable Care Act and other state and federal laws. Often, with these plans, the devil's in the details; for instance, an insurance plan with low monthly premiums may have exceptionally high deductibles or strict limits on access to certain types of services.

While Medicare also offers different health care plans, it's an entitlement system that U.S. citizens pay into through taxes. Since Medicare isn't a business like many of their private sector insurance counterparts, there's no motive to maximize revenues. This can incentivize efficiency and outcomes instead of profit, as proponents of single-payer health care like to point out.

Medicare for all, therefore, would eliminate private insurers. Instead, Medicare (or some other federal entity) would serve as the intermediary between patients and existing health care providers. Since the government would be paying for these services, it likely would require an increase or reapportionment of taxes.

Single-Payer Health Care in Other Countries

The vast majority of industrialized nations, many of which guarantee the right to health care in their constitutions, offer some form of single-payer health care. Canada, for instance, has a system consisting of 13 provincial and territorial health insurance plans. They're administered within each territory or province in accordance with federal regulations, similar to the U.S. Medicaid system.

So while there are technically 13 payers in the Canadian system, it effectively operates like a single-payer system. The health care providers themselves are mostly private entities, as in the United States, and patients receive care at virtually no cost other than through taxes.

Other countries with single-payer health care systems include the following:

  • Taiwan - Started in 1995, coverage reached 99 percent of the population by 2004. Paid for through a combination of payroll taxes and direct government funding.
  • South Korea - Federal reforms started in the 1970s resulted in universal coverage by 1989, with all medical coverage paid through a single entity after reforms made in 2000.
  • United Kingdom - England, Northern Ireland, Scotland, and Wales have separate systems of publicly funded health care, supplemented with voluntary private insurance for coverage of additional services.
  • Australia - Australia's Medicare system is funded by a 2 percent income tax and operates in tandem with a private health care system for those who elect (and can afford) additional coverage.
  • Spain - Beginning in 1986, Spain established a publicly funded health care system, with management delegated to the country's various autonomous regions. Spain also allows for private insurers, which covers nearly 15 percent of the population.

Attempts at Creating Single-Payer Health Care in the U.S.

The most notable attempt at legislation creating a single-payer health care system in the United States was forged by now-retired U.S. Representative John Conyers (D-MI) in 2003 (and reintroduced each year until his departure in 2017). The Expanded and Improved Medicare for All Act (H.R. 676), modeled after the systems used in Canada and Taiwan, would replace private insurers with a universal single-payer system.

Nearly a dozen states (as of June 2018) also have proposed legislation calling for the creation of single-payer health care programs. For example, the "Healthy California Act" (SB 562) introduced in 2017 would grant health coverage to California residents without premiums, deductibles, or co-pays. The $400 billion system would be paid for through the creation of a trust fund that would pool state resources with federal funding.

Other states whose lawmakers have proposed single-payer health care include Illinois, New York, and Minnesota.

Get Legal Guidance on Your Important Health Care Decisions

Since the United States doesn't have a single-payer health care system, there are a lot of players involved, including health management organizations (HMOs) and private insurers. This means patients really need to do their homework and read the fine print. If you have questions about coverage or need representation, your best option is to meet with an experienced health care attorney near you.

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