What is Single Payer?

Single payer is emerging as a potential solution to health care woes in the United States both on some state levels as well as in a recently proposed bill by Bernie Sanders. Single-payer national health insurance, also known as “Medicare for all,” is a government system in which a single public or quasi-public agency organizes health care financing. As with the delivery of current health care, the delivery of care remains largely in private hands. Under a single-payer system, the goal would be to provide all residents of the U.S. all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

As of this date the concept, proposals and reactions are unfolding and there are a variety of issues and questions that need to be resolved. The key issues are the cost and who pays for it, the increase in taxes to pay for it. A big concern is the shift from employer to government of health care plans and what the impact of this would be for the millions that currently receive their health insurance from their employer.

Currently, 49% of Americans have health coverage through their employer (7% have non-group coverage, 36% have public insurance, and 9% are uninsured, per the Kaiser Family Foundation, kff.org). These employees aren’t getting health insurance for free. They pay for their insurance benefit through foregone wages. But it often looks to them like they are getting insurance for small premiums, if not for free. If they have to pay for their insurance through increased taxes, many will likely perceive that they have suffered a net loss.

Medicare for all poses separate problems. It is by design an “acute care” program. It does not cover long-term hospital stays or nursing-home care, and excludes some routine care (e.g., dental and vision care). Presumably a single-payer program designed to replace all or most private insurance would be more comprehensive than Medicare.

Medicare Parts A (which covers medically necessary hospital services), B (which covers doctors’ fees and some hospital outpatient services), and D (prescription drug benefits) all have sizable deductibles and co-payments. That is why most seniors who can afford it buy supplemental insurance to cover such “cost-sharing measures” (poorer or disabled seniors who also qualify for Medicaid get fuller coverage through that program). Parts B and D also charge monthly premiums, which most seniors pay through automatic deductions from their Social Security checks.

Some version of Medicare for all could be the public option that was not set up when ACA passed. That would be in competition with private carriers. It wouldnt be single payer unless the tax deduction for employer paid insurance were eliminated. There are politicians proposing that; freeing American companies in competition with other countries and driving mass of people into indl market, which would eliminate need for the mandate. In the meantime, getting people to give up what they have and unemploying an entire industry seem like huge hurdles to any single payer scheme.

Here are some articles and content that offer more information and perspectives:

The Sanders Medicare for All Act:
Executive Summary: https://www.sanders.senate.gov/download/medicare-for-all-act-of-2017-executive-summary?id=943E7DB5-FCCA-4EA4-B215-A92F6642BA2C&download=1&inline=file

The actual bill: https://www.sanders.senate.gov/download/medicare-for-all-act?id=6CA2351C-6EAE-4A11-BBE4-CE07984813C8&download=1&inline=file