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The Single Payer Health Care Debate

Edward Neeman | Published: June 14, 2018

Health care protesters

Single payer health care has long been a topic of discussion here in the U.S. as well as other countries around the world. While some may use the term single payer to include other forms of universal healthcare, there are countries who have adopted single payer systems or hybrid single payer systems, and have found success.  

Other countries are hesitant to follow suit due to the potential drawbacks of a single payer health care system.  With the current push for healthcare reform in the U.S., single payer health care has once again become a hot button topic.

What is a Single Payer Health Care System?

Also referred to as Medicare for All, single payer health care refers to a system where taxes are collected by a central governing entity, which are used to provide health coverage and services to the population.  In the U.S., the care would remain in the hands of the private hospitals and doctors.  In a true single payer health care system you would not have to pay premiums, deductibles, copayments, or any other out-of-pocket expenses, because they would be included in your taxes.

Single Payer Health Care vs. Universal Health Care

Many confuse the terms single payer health care and universal health care, or use them interchangeably.  There are some key differences between these two health care systems.

Difference Between Single Payer and Universal Health Care

As explained earlier, single payer health care refers to a system where the government is responsible for administering and paying for its population’s medical services.  Universal health care refers to a system where the entire population has health coverage.  

A universal health care system would still leave room for the private health insurance sector to thrive. Universal health care just means that every citizen has access to healthcare, or has health insurance, it does not mean that every person has the same level policy.  

Countries with Single Payer Health Care

Single health care systems, or similar forms of universal healthcare can be found in throughout the world.  While there may be some variances between how the single payer health care system is administered, and how medical services and funds are overseen, by in large these countries have found success with single payer health care, or single payer hybrid systems.

Cuba 

Cuba probably employes the closest thing to a true single payer health care system.  In Cuba, there are no private healthcare providers or facilities, everything is run by the government.  

Denmark

As a world leader in healthcare technology, the average life expectancy seeing a dramatic rise in the last 10 years,  and 1 doctor for every 294 citizens, it’s easy to see why many look to Denmark as a beacon of hope that single payer health care can work.   

While many may boast Denmark is a successful example of a single payer health care system, they are not true to the definition.  Healthcare is funded through regional or municipal taxation rather than one central government.  The role of the central government is to regulate, pass health legislation, provide guidelines, and give advice and health information to the local levels.  

Germany

Germany has a dual health system.  German citizens are either required to be part of their compulsory health insurance, or purchase private health insurance.  The compulsory health insurance is paid for based on a person’s pre-taxed income, which means those with higher incomes help pay the costs of those with lower income.

Australia

The healthcare system in Australia offers the service as a combination of independent medical practitioners and hospitals run by the government, and are funded by both the government and the private insurers with the patient paying a partial amount.

Botswana

Bostswana employs a version of universal health care, but private healthcare is also available to those who prefer it.  It affords health coverage to all its citizens through taxation, although check ups still have a small out-of-pocket fee.  It’s estimated that the government runs 98% of all healthcare facilities.  

Pros and Cons of Single Payer Health Care

There are multiple advantages and disadvantages to consider before moving to single payer health care from a free-market system.  The pros and cons are the primary topic of conversation when it comes to political discussions, and have been significant in dividing the country in two fractions.  Those who are for single payer health care, and those who are against it. 

Pros of Single Payer Health Care 

Medicare For All 

In single payer healthcare system, everyone is afforded the same opportunities to see a doctor when they are sick, have an injury, or need treatment. Regardless of your financial situation, you will be treated, because single payer health care focuses on ensuring the health of the entire population.

Preventive Services 

Another benefit of single payer health care providing free preventive services.  Being able to see a primary physician, or general practitioner can catch health issues in populations before they worsen.  Catching a health problem early on, or before it can manifest is far less expensive than treating the same health condition. 

Coverage Everywhere

In a single payer health care system there are no health provider networks to worry about.  With private insurance, depending on your plan type, you may have a limited number of health providers you are covered with, especially when you travel throughout the country.  With a single payer system, you can travel anywhere in the U.S. and have access to any health provider. 

Cons of Single Payer Health Care

Doctor Shortage & Wait Times 

With less money to be made due to negotiated prices and spending caps, there may be an exodus of health providers leaving the field, including doctors.  The long and expensive road to becoming a medical provider is usually rewarded with a more than favorable compensation.  If doctors don’t see the same high figure payouts they may be deterred from pursuing a job in the medical field all together. 

Let’s take a look at Canada for example.  A recent study by the Fraser Institute brought to light some shocking revelations about the state of healthcare in Canada who employs a version of single payer health care.  In 2016, the wait times to see a medical specialist averaged about 20 weeks.  This means that people who were in need of medical treatment were unable to efficiently receive the care they needed.

High Taxes 

The pool of cash that is used to fund the single payer system has to come from somewhere, and in this case, funds would come from taxation. A good example is the US through the Medicare and Medicaid health services, which cost taxpayers over $3 trillion each year. The programs are funded through the raising of sales and corporate taxes as other countries are increasing gasoline taxes to supplement the system.  

Less Innovation

In a free market innovation rules all.  Private health providers are willing to fund research to bring the newest technology to their facilities to increase their profits.  These innovations not only create a more efficient system, but provide higher quality treatment at lower costs.

With single payer health care, it would be difficult to argue that innovation in the medical field would see the same strides it has in recent years.  Historically, programs overseen by the government aim to limit budgets and spending, which would mean less funds would be allocated to research and development.

Single Payer Health Care Controversy

Single payer health care has yet to make it’s way to the U.S.  Each time the idea is tossed around, it quickly becomes the center of political discourse, and sides form.  Usually, the DNC takes the side in favor of single payer health care, or a universal healthcare system that is similar to single payer, and the GOP is adamantly against the idea. 

The controversies are so many and do not only involve politicians but the general public as well. Those against single payer health care will often cite other countries struggles with wait times and quality of care. As you can imagine, people would not be thrilled with the idea of not only paying for other people’s health coverage, but being forced to take a backseat for medical services they paid for.

On the other side of the political spectrum, many feel that health coverage should not be considered a good or service, but rather a constitutional right.  The claim stems from the moral stance that healthcare should be available to all who need it, not just the select few who can afford it. 

Taxes - The Double Edged Sword

Others are concerned with the higher taxes.  The argument is essentially a double edged sword.  On one hand you pay more in taxes each year, but pay significantly less when it comes to your health coverage.  In turn, the money you pay for taxes is actually less than you would be paying if you purchased private health insurance, because the cost of health services will become less expensive.  Some see this as health savings.

On the other side, the wealthy will be seeing a higher tax hike than the lower and middle class.  The upper class are typically the ones who can afford premium coverage through the private sector, which comes with more comprehensive and higher quality coverage.

Also, those who are healthy may not want insurance at all, but with single payer health care, these people would be required to pay for health coverage regardless of if they use it or not.  In their eyes, single payer health care doesn’t mean saving money on health coverage, it means more expenses that they would prefer not to pay.

DNC vs. GOP Stance On Single Payer 

The single payer, health care system, is a raging fire between the Democrats and the Republicans. While the GOPs are looking into rolling back the system, the DNC is focused on seeing it through. The stance made by each part proves that the universal health care system is a divisive proposition.

DNC On Single Payer

The DNC is not known to shy away from endorsing a single payer health care system as shown by historic policies they have implemented, such as Obamacare. They are of the idea that the system provides a level of equality for all because healthcare is available to all.

The system is, however, not supported by every DNC member as others say it doesn’t make sense, and that it will require a massive increase in tax.  Many feel a multi payer health care system would be a better fit for a country of our size.

GOP On Single Payer

The GOP is not to keen on the idea of a single payer health care system.  They speculate moving to single payer health care would end up costing taxpayers $32 trillion in the coming years. This is led by current GOP President Trump who thinks it is completely unaffordable. 

The GOP believes single payer health care is not sustainable, and highlight Obamacare as a flawed attempt for Medicare for All.  The GOP has been actively attempting to repeal Obamacare since it passed in 2010, and will continue to try and repeal it until they are successful in doing so.  This can be taken as a summary of the GOP’s feelings towards single payer health care.