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Universal Healthcare and Single Payer Healthcare Are Not The Same Thing

Meredith Miller Published: June 14, 2018 Updated: November 13, 2018

American flag constitution stethoscope

Last year's debate over the future of Obamacare and this year's discussions over the future of Medicare and Medicaid have helped propel healthcare policy into the national spotlight. Many people have wondered what exactly should be done about healthcare in America. In addition to repealing Obamacare and cutting Medicare or Medicaid, some thoughtful politicians and activists have proposed imposing some form of universal healthcare or single payer healthcare. Both terms have similar meanings. However, the differences may lead to massive political and economic changes in the American healthcare system over the next few years.

Single Payer: A Common Global System

Single payer healthcare is a proposal that has recently gained traction in American political discourse. Prominent politicians like Senators Bernie Sanders and Elizabeth Warren have touted the possible benefits of single payer, especially since the 2016 election. However, the idea is one that has existed for some time in other countries around the world. Single payer healthcare means that one entity pays for the vast majority of health coverage that a country uses. In most single payer countries, this single payer is the federal government. The federal government may work through different providers and nonprofits in order to actually distribute care to the masses, but all of those other providers receive all of their funding from one source.

Single payer healthcare increases taxes that the average individual has to pay and increases the size and spending amounts of the federal government. Health care decisions are handled by providers and the government in concert. The government often pushes for research and development along with advertising for pharmaceuticals and other healthcare services. In exchange for government control of payments, those who live in countries with single payer healthcare are able to reduce their overall liability for health care procedures. They also do not have to pay for the myriad of costs associated with health insurance companies. Those costs include billion-dollar compensation packages for executives and multi-billion dollar advertising blitzes for designer pharmaceuticals. Both expenditures would go towards paying for care and making care more efficient in a single payer system.

Universal Healthcare: More Possibilities For Care

Universal healthcare is a more disparate approach to achieving the same goals. It is an expansion of President Obama's health care plan and earlier plans proposed by Bill and Hillary Clinton in the 1990s. At its heart, universal healthcare is a governmental system where the right to healthcare is guaranteed. This guarantee can be met through a number of different methods. One is through the single payer systems that predominate around the world. However, there can also be an approach to universal health care that does not have a single payer.

An example of this is through an employer-based or individual mandate. The idea of an individual mandate for universal healthcare is that every individual is forced to purchase health insurance or be provided that health insurance from an employer. Those who are not employed or too poor to afford insurance can receive subsidies or sign onto government-run programs such as Medicare and Medicaid. They receive a tax penalty if they are unwilling to purchase health care coverage after those efforts are made by the federal government.

This effort reduces the overall expenses for all users by ensuring that nobody can act as a "free rider" and use the emergency room as their health insurance plan. Unlike Medicare or Medicaid, universal healthcare expands this guarantee past age or income. However, it still keeps the structures of private health insurance in place and allows them to flourish along with government support through programs and subsidies. Individuals have to trade this greater flexibility for potentially higher costs through the inefficiencies of profit-motivated companies.

Universal healthcare and single payer healthcare will continue to stay in the public discourse. The public is clearly unhappy with Obamacare and planned alternatives which may push for the pursuit of universal healthcare or single payer healthcare. It is imperative, then, that American citizens know about potential health care changes and become familiar with the terms being used. The future of their health is at stake.