¶ … controversial concepts is the proposed solution to the healthcare system in the U.S. is the movement towards a single payer system similar, to the systems found in virtually every other advanced nation in the world. The Affordable Care Act was argued to be significant step towards a single payer system, and although the system is technically far short of what could be considered a single payer healthcare system, even the mere expansion of healthcare access in the U.S. has been controversial, polarizing, and has had significant opposition. Those in favor of single payer, have typically pointed to successes in other countries relative to cost efficiencies and health outcomes. In fact, the United States is the only country in the Organization for Economic Cooperation and Development (OECD) that relies heavily on out-of-pocket expenses (OOPs) and private health insurance to fund its healthcare system (Sumalinog, Abraham, & Yu, 2015). This analysis will focus on one of the pioneering efforts to implement such a system in the United States and the potential for such a system to be implemented in the future. Implementation Matters

McDonough (2015) investigated the Vermont single payer system attempt and the evidence indicated that public support for the system...

Furthermore, there have also been issues with the implementation of the system that include funding formulas. Based on such evidence, the argument is made that push for single payer in Massachusetts maybe unfeasible to implement. Other research corroborates these findings and argue that as Vermont demonstrates, to design and adopt a single-payer reform that can withstand the legislative process is possible, but the odds of successfully implementing such a system in other states may be even lower than in Vermont (Fox & Blanchet, 2015)
However, these arguments are founded on evidence from one specific attempt from a single U.S. state. However, numerous examples of successful implementations are available from outside U.S. borders. For example, Canadian provinces have been able to administer a single payer for decades. Candia first implemented a single payer system in the 1960s, many Canadian provinces have a similar population demographics as Vermont. However, one of the fundamental differences is that Canadian hospitals are run by government agencies, usually regional health authorities, and only doctors are private, and they are still subject to standards outlined in the single payer system (Robinson, 2015).

What McDonough proposes is a slightly different in terms of how it perceives the debate. The argument is not based on the ethical qualities of a single payer, but rather about the implementation of it. There are several persuasive opinions that a single payer healthcare…