¶ … 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...

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…