The Single-Payer Health System

Lindsey Mattila (CMC ’17)

The United States is currently the only developed country that does not have universal health coverage. While the Affordable Care Act provided access to healthcare for millions of people that would have otherwise been unaffordable, nearly 13 percent of the American population, ages 18 to 65, are still uninsured. Beyond extending coverage to all American citizens, a single-payer system could have financial benefits for individuals and the government alike. Still, there are many weaknesses to a single-payer plan, which is why it has not yet been implemented. Though a single-payer plan may not be politically feasible in the foreseeable future, the defeat of the American Health Care Act makes clear that accessibility is important to the voters. In order to cover all of the uninsured, President Trump may need to consider a policy option more comprehensive and robust than the AHCA.

The current healthcare system in the United States is complex and costly. This is mostly due to the thousands of healthcare plans offered. Additionally, there are many different ways to receive healthcare– through employers, the individual market, the government, and so on. Consequently, people with different plans in different geographical locations could be paying extremely different prices for the exact same procedures. Some of this complexity contributes to the high costs of healthcare in the United States, and researchers believe that a more streamlined process could reduce costs. The American Health Care Act would not do this, even though President Trump ran on a campaign platform advocating for “insurance for everybody.” The new Act would actually kick many elderly out of the insurance market due to an increase in cost for insurance and would incentivize more young people to enter. It seems this solution is simply a band-aid to the real underlying problem that neither this Act, nor the Affordable Care Act, address head-on: this system is far too complex.

Thus, many think the United States should move toward some type of a single-payer system, of which there are many variations. What all of these systems have in common is that hospitals will only receive payment of bills from the government, as opposed to the current system where they receive payment of services from individuals, insurance companies, and employers. Instead of insurance companies competing to be the middleman between hospitals and patients, the government will step in this role instead. There are a few benefits to this plan. First, although it would increase federal spending, it would cut down on healthcare spending per capita. For example, currently, 15-30 percent of healthcare costs are a result of administrative services, such as billing. If billing and services were more streamlined with fewer stakeholders in the healthcare industry, these costs could be minimized. Additionally, insurance companies currently spend up to 20 percent of customers’ premiums on advertising costs- a service that would not be necessary without competition. Second, having the government as the sole funder would give it more power to put controls on costs and spending, and would give it more power to negotiate with pharmaceutical companies. Lastly, it would allow American citizens to be insured starting on the day of birth, giving President Trump the opportunity to fulfill his promise of insuring all.

On the other hand, there are a few downfalls to this system. First, the government gets to decide which services it thinks are necessary and provide funding accordingly, which means that services it deems unnecessary will lose funding. If the government lacks sufficient funding, especially in the initial stages of implementation, people could still be paying out-of-pocket for the services deemed unnecessary. A second criticism is the potential increase in wait times for non-urgent care as doctors increase their patient load to accommodate the increased number of insured people. Third, in some single-payer systems, there are still problems with doctors over-prescribing care in order to increase revenue. In this instance, a single-payer system may not cut down healthcare costs a significant amount. Lastly, there is concern that a decrease in competition would possibly decrease innovation in the entire healthcare sector.

Most importantly, however, Americans are extremely distrustful of the government and are hesitant to allow the government to have control over more areas of their lives. Although the increase in taxes would likely balance out with the decrease in premiums and deductibles, polls have still shown that Americans are more uncomfortable with their healthcare costs being represented in their taxes than in hospital bills. Furthermore, a single-payer system is a step into the unknown, and though Americans dislike the current healthcare system, they are concerned about the risk of disliking a new one even more.

Citizens would not be the only tough critics of this change. Conservative politicians, pharmaceutical companies, insurance companies, and certain doctors would likely be staunch opponents of this as well. Although such a drastic change is unlikely, politicians are starting to realize that legislation like the ACA and AHCA can only help certain people, while excluding others. Examining the policies of a single-payer system will be an important step to make legislation more inclusive. To truly insure all, they will need to look beyond the band-aid, and fix the underlying problem by streamlining the healthcare process.

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