No matter where you live, what you do or where you find yourself on the political spectrum, you probably keep up with the healthcare debate to some extent and have an opinion on it. It is easy to get lost when politicians, pundits and reporters talk about healthcare. To simplify the debate a little bit, there is an ongoing argument about whether or not the U.S. should have a multi-payer healthcare system or a single-payer system. There are some things between those options, but we will get to that later.
Multi-payer means citizens purchase insurance coverage. It is called multi-payer because citizens choose their insurance provider, which leads to multiple insurers and therefore multiple payers.
Single-payer means there is one payer of health insurance coverage and that payer is most often the government. There are no private insurers involved.
Most of the debate, as usual, is about money. All payers want affordable healthcare. A lot of the debate today focuses around the Affordable Care Act and whether or not it is the best healthcare option for Americans. Many argue the Affordable Care Act is a starting point, others argue it needs to be abolished entirely and a whole new system implemented.
The Affordable Care Act is a complicated debate in and of itself, however it has been a starting point for many companies and individuals to explore other options for health insurance, including single-payer. Most companies and individuals aim at finding options for reducing insurance rates, yet ensuring individuals remain covered. So far there are multiple options for how to reduce insurance rates, but those options are widely debated and highly politicized. Here is the breakdown.
What is Single-Payer?
In most single-payer or universal healthcare systems, the government pays for most of the insurance, but not all. And that is due to the high cost of healthcare coverage. In these systems, the government pays for most of the insurance costs and citizens have two options.
Citizens can decide to purchase a supplementary private insurance plan that pays for the coverage the government excludes. For example, the government often excludes dental care. A supplementary insurance plan would allow you to purchase dental coverage. Or, citizens can purchase a complementary insurance plan which compensates the co-pays and deductibles in the government plan.
This is how traditional Medicare operates in the U.S. The government pays for some healthcare, but people often buy complementary plans from private insurers. These private insurers cover dental care, prescription drugs and other services.
Cost of Single-Payer
Common rhetoric in the healthcare conversation today suggests that single-payer would “bankrupt our country.” That depends on where our single-payer system would lie on the spectrum.
Sen. Bernie Sanders suggests a plan where essentially the government would pay for everything. His website entails a plan with eliminated copays, deductibles and fighting with insurance companies when charges accrue to the individual.
This system could cost the government — depending on who you talk to — between $1.38 trillion per year to $2.8 trillion per year.
One thing to understand is that Sander’s plan is one version of a single-payer plan, not the only single-payer plan. Other plans would far reduce how much the government spends on healthcare per year, by only paying for some of citizens’ healthcare.
Universal healthcare lies on a spectrum from the least pure systems to the most pure systems. The least pure is when governments offer the least comprehensive health insurance where citizens need to purchase either a complementary or supplementary insurance plan.
The purest systems occur when the government is able to offer the most comprehensive healthcare coverage with little to no need for private insurance. The purest system is close to what Sander’s plan is.
On the State Level
Some individual states have looked at implementing a more local healthcare system as they wait for the national conversation to get serious. These states include Massachusetts, Vermont and California.
In Massachusetts, the state approved a broad healthcare reform bill that seeks to lessen the price between different hospitals, address drug costs and lower the number of patients admitted to a hospital. They also added an amendment calling for a study to see how viable a single-payer option would be.
Vermont had attempted to implement a universal healthcare system, but the taxes became unmanageable. Today the state is moving toward a different system designed to incentivize doctors to keep people healthy instead of having them admitted to treat illnesses.
California is operating under the Covered California plan that offers subsidized Obamacare plans for the state. This state has the most comprehensive plan in the works, but it has stalled due to the potential increase in taxes and the lack of plan behind how to pay for it.
Future of Single-Payer
With the constant talk and threats of repealing and replacing the Affordable Care Act going on in the White House and on Capitol Hill, Democrats — including, but not limited to Bernie Sanders — are talking about how to implement a single-payer system.
Our healthcare system will not be an easy fix. A country as big as America will face many unique challenges trying to implement plans that have worked well in other countries. However, some version of a single-payer plan could be a great alternative to the current proposed healthcare legislation, which has received widely unfavorable reviews.
Kate is a health and political journalist. You can subscribe to her blog, So Well, So Woman, to read more of her work and receive a free subscriber gift! https://sowellsowoman.com/about/subscribe/