Since the single-payer healthcare system is not only a long-debated issue, but also a presidential campaign discussion topic, with one of the candidates supporting the idea of the US healthcare system restructuring into a single-payer type, it would be useful to shed some light on this concept.
Moreover, the Atlantic conducted a survey on what single-payer healthcare represents for 1,033 adults and found out that while 33% support this system and 29% of the study subjects oppose it, many people don’t know what actually having a single-payer system would imply. The article that mentions the survey results is actually opposing this healthcare system, but the idea that people need to make an educated choice is nevertheless important.
An overview of single-payer healthcare
Single-payer healthcare only refers to healthcare funding, and it implies that the state supports all healthcare costs, replacing various private insurers. In turn, the state has the possibility of contracting services from private organizations and may become a direct employer of healthcare resources.
The state via specialized agencies manages the health fund made out of all collected medical fees and offers healthcare coverage for all contributing citizens. This system has its characteristics, one of them being that the overall coverage cost per person would be lower, since the coverage plan is tailored to fit one and all.
Another characteristic of this type of medical coverage resides in the huge buying power that would be coordinated by the same entity – translate this into the same decisions, same market moves, and coordinated policies. The source quoted for these two system traits is not official (a Reddit discussion) – but still it is worth mentioning that, from this angle, the single-payer healthcare system means that a vast buying power would “leverage negotiation with pharmaceutical companies and hospitals for low rates”.
*The benefits and disadvantages of a single-payer system are one thing, and the entire havoc of scrapping the already existing American healthcare system in favor of a new paradigm is another thing. When criticizing the idea of an American single-payer system, many sources overlap the two, partly because it serves the opposing stance and partly because this double-difficulty reflects the reality. Social systems are not like parts in a machine – stop the machine, take out the old part and insert the new one. The transition from one system to another would be a very complicated process indeed and it would require a strong engagement that would cover the difficulty gaps. Implementing an innovative idea (innovative for the U.S. at least, since other states do have ongoing functional single-payer systems), materializes into a long-time deployment that will comprise a lot of changes and probably a lot of frustration – the kind of gaps only a majority acceptance would help in bridging.
Benefits of the single-payer system:
The American Medical Students Association lists in its 2015 informative material on single-payer healthcare the following benefits:
- The coverage would include all necessary medical healthcare (while the financing would not include interventions deemed unnecessary by the specialized board) and supplementary coverage would be available via private insurance; such a system would enable real health planning;
- While the funding taxes would increase for individual citizens, the employers would pay less for their employees’ benefits, having the possibility of increasing the wages; the individual tax increase will be compensated by “reduction in premiums and out-of-pocket spending”;
- Physicians will be able to remain in private practice or working for private hospitals while having the complementary possibility of 3 reimbursing methods from the NHI program (fee-for-service; salary at healthcare facility or salary within a capitated group);
- The NHI program would negotiate prices for drugs and supplies with the suppliers and manufacturers, being able to obtain a better price due to its bulk purchasing power;
- The single-payer system will save money since administrative costs would be lower; cost control is also easier to maintain in a centralized system;
- Patient benefits include improved healthcare with eligibility starting from the minimal income, and better preventive/primary care; free choice of provider and the portability of health insurance coverage, regardless of their decision to change their place of work;
- Physician benefits would translate into increasing their clinical autonomy once the private insurance companies do not have to pre-approve interventions and review their decisions; lower malpractice premiums since the continuity of care allows patients to choose their physician more willingly and not change their doctor due to changing their insurance company; patient care based on best practices and inherent medical reasons instead of insurance/financial circumstances reasons, as well as a much simplified billing system;
- Advantages for employers/businesses: lower healthcare costs (since this financial system benefits a vast amount of people at a low to medium coverage level, instead of paying for the high coverage peaks of premium insurance); an equalized playing field since all businesses would have to pay an even payroll tax for funding the new system and leveraged contributions further on, eliminating the unbalanced situation of businesses that do not offer healthcare for their employees versus businesses that do, and, finally, an overall improved global competitiveness in the relation with foreign companies that abide by the rules of better, more beneficial healthcare insurance systems.
Disadvantages of single-payer:
- The main disadvantage mentioned by the AMSA paper is the risk of under-funding the new system coming from the part of a hostile government: the single-payer system would be compromised in such a case and all involved entities would have to suffer – the mere idea of single-payer being in consequence compromised;
- Administrative mismanagement, comprising all possible situations, from the personnel being unable to cope with the necessary requirements to corrupt government taking advantage of the taxpayers’ money;
- The inherent dangers that derive from using tax dollar for financing a system, such as supporting possible recession effects (decreased value of the national currency).
Other commonly mentioned cons to single payer include:
- the government control over physicians, research universities and medical equipment manufacturers;
- the possibility of reducing development in the medical field;
- the common disadvantages of a more protective state social system that come from less advantages for the more financially empowered people versus more advantages for the financially challenged individuals;
- extended waiting times in the healthcare process;
- possible doctor shortages if all the population is to benefit from medical services and also derived lower healthcare quality, since the doctors would have to reduce the time dedicated to each patient in order to see all those waiting in line.
As we can see by summarizing the pros and cons to the single-payer healthcare system, the concept is not to be overlooked
Nevertheless, there are a few critical elements to consider:
- SP healthcare involves a big shift at a conceptual level for the American citizens;
- A new such system would absolutely need the majority of the current medical market forces to be on board in order to have real chances;
- There would be unpleasant changes to go through as well;
- It would increase government control and reduce the freedom of choice in its strive to offer coverage to all insured citizens, although supplementary coverage is possible;
- Although the funding mechanisms would be taken over by governmental forces, when in supplies and drugs negotiations the other side remains private – how will the private companies from the healthcare system react to the single-payer system?
