American Healthcare Reform Debates

¶ … payer healthcare systems: Pros and cons One of the most controversial concepts in American health care is the idea of single-payer health insurance, or the notion that healthcare will be supported by taxpayer dollars, versus funded by private insurance companies. In many Western industrialized nations such as the United Kingdom and Canada, the concept of single payer-health insurance is the norm and embraced by the majority of the population. In the United States, the rhetoric of socialism and state support has caused people to fear the concept.

Even the Affordable Care Act (ACA) was painted by some aspects of the media as a move towards a single-payer system because it exerted somewhat greater control over individual's health-related choices, such as mandating that all American citizens have health insurance. However, the ACA was far from socialized medicine given that it continued to ensure that the majority of Americans not on Medicaid or Medicare obtain health coverage from private insurance companies. Support for single-payer health insurance has been weak the United States, even in relatively politically liberal areas.

According to McDonough (2015), the state of Vermont has come closest to implementing a single-payer system. In 2010, Governor Peter Shumlin was elected on a platform promising a single-payer system. In 2014 election, Shumlin won the election only by a razor-thin margin, however, and his opponent had capitalized upon Shumlin's support for single payer insurance in a negative fashion. The ACA was extremely unpopular at the time and polls suggested that only 40% of Vermont residents supported a single payer system, despite the state's reputation for liberalism (McDonough 2014).

Shumlin cited his withdrawal of support for single-payer insurance based upon a controversial 2014 state review of the issue which "predicted 1.6% savings over 5 years and foresaw required new taxes of 11.5% for employers and up to 9.5% for individuals" (McDonough 2015). The most successful state healthcare reform initiatives have been examples such as Massachusetts, which created a system of universal healthcare long before the ACA.

"Massachusetts enacted several reforms to the private insurance market including, requiring guarantee issue, whereby insurers have to issue plans to any eligible applicant regardless of health status, and community rating, which allows for only limited variation of policy price within a given area and prohibits insurers from charging people more based on their health status or claims history" ("Massachusetts Healthcare Reform," 2013).

In a manner very similar to the federal ACA, it enabled residents to purchase health insurance on a statewide exchange, expanded subsidies to specific groups, and also created an individual mandate to have insurance for state residents ("Massachusetts Healthcare Reform," 2013). Massachusetts now has the lowest number of insured residents in the nation; however, it has not been able to curtail healthcare costs.

"Per capita health spending is 15% higher than the national average and although premium growth has slowed in recent years, Massachusetts has the highest individual market premiums in the country" ("Massachusetts Healthcare Reform," 2013). Critics in favor of a national single payer system point to problems with the Vermont and Massachusetts experiments, as well as problems with the ACA as evidence of the need of a single payer system. Opponents of single payer healthcare often cite problems with the Canadian system and other nations who have the policy in effect.

Long wait times to see physicians are one of the most frequently-cited issues although it could be noted that this concern also arises in the United States, as does denial of care for unapproved procedures by private insurance companies in the U.S. versus the nationalized system in Canada where hospitals are funded by government agencies in the form of regional health authorities. Technically physicians work for the private sector Canada but they must operate within the publically-funded single payer system (Robinson, 2015).

Other objections to single-payer systems include the fact that "in single-payer systems spending on health care is pitted against other government priorities and easily falls victim to the politician's perennial desire to campaign on tax cuts. The barebones technology, physical amenities, and queues that unduly low global budgets in single-payer systems" (Reinhardt 2007). Also, the relatively lower cost structure within single-payer systems means that there is often less money in circulation to support healthcare innovation.

"To be sure, the low prices it forces on the system allow society to provide more real health care for a given budget than could be delivered in a more expensive pluralistic system, and it also makes universal health insurance coverage more affordable.

On the other hand, the extremely low profit margins it yields the provider of health care makes single-payer systems less hospitable to innovation in healthcare products and services and in the organisation of healthcare delivery, areas in which the United States excels, sometimes to the point of excess" (Reinhardt 2007). Regardless of the merits of equity provided by single-payer systems, there seems to be little political will in the United States, even in the most liberal areas, to support it.