Single Payer or Universal Health Care

In Favor of Single Payer Health Care
The American health care system is broken. On this much, almost everybody can agree. Costs are spiralling out of control, health outcomes are among the worst of all developed countries, and nobody can agree on what will make it better. One of the reasons for this disagreement is that different stakeholders fail to agree on what the purpose of the health care system should be. If the purpose is to be a for-profit industry, well, then the industry needs to be set up to earn profits. But the view taken in most parts of the world is that health care serves a greater purpose. Whether this is to provide a high standard of living for people in a country for its own sake, or because healthy populace is better for the economy, such finer points can be debated. But what cannot be debated is that each and every one of us wants to live longer, healthier lives, we want our friends and families to live longer and healthier lives, and the economy benefits from healthier workers. If we can all agree on those three things, then maybe we can start to think of how to design a health care system that will deliver them. That’s what single payer does.
The Physicians for a National Health Program (2019) describes single payer as a “Medicare for all” type of system in which a public agency organizes health care financing but the delivery of care remains largely in private hands, as opposed to a universal health care model like exists in Canada or the UK. The reason single payer makes more sense in America is because the delivery of health care is largely set up for private enterprise, and a shift towards nationalizing care would be jarring; a shift towards single payer simply replaces private insurance with public insurance.
Most single payer systems deliver health care at a lower cost, and higher effectiveness, than the current system in the United States. They do so by eliminating profits from the system, reducing administrative costs, and imposing cost controls, such as price caps on prescription drugs. The absurd charges and enormous waste in our system is not possible in a single payer system because cost controls are much stronger. By cutting these high administrative costs, the overall cost of health care will be lowered (Chrisopher, 2016).
This is not to say that single payer is without its problems. The Canadian experience shows that single payer solves a lot of problems regarding access to care, quality of care and administrative costs, but that it also creates a bulky system that can be slow to react to change (Ivers, et al, 2018). But here’s the thing with problems – if you know about the problems ahead of time, you can design a system that solves them. An American version of single payer does not need to look exactly like the Canadian version, or anybody else’s version for that matter. Private health care providers, in fact, can retain the ability to innovate, if the system is designed to be responsive to innovation in the way it pays out to physicians.
One of the problems that is often cited is the matter of cost. Instead of employers paying for insurance, or insurance provided through programs like the Affordable Care Act, taxes would increase in order to pay for single payer. Even proponents of single payer accept that this is likely to be quite unpopular, and is one of the reasons why there is little political will be implement a single payer system. But if the overall cost of health care will decrease, the burden paid by American workers will decrease as well, overall, assuming that they can benefit from decreases in payroll taxes, for example. A single payer system has to be designed so that the cost savings from dismantling the private insurance system flow to the American worker, in order to offset the increase in taxes that they will see.
It is important to remember that when you see objections to single payer, usually those objections reflect perceived problems with the change in systems. But once anticipated, we can devise a system to minimize or eliminate those problems. There are no intractable problems in making this shift, and that is something to always keep in mind.
We all want the best health care possible. Right now, we are not receiving it. Or at least, most of us are not. And many of us do not receive health care at all, for lack of insurance. Among those who have insurance, the plan often comes with high deductibles that make getting care difficult. Pharmaceutical prices are through the roof, and yet in other countries drug companies earn profits despite price caps. There is no need to allow unfettered profit-taking that makes it impossible for many Americans to receive the high quality of health care we all deserve.
A move to single payer is the right thing to do. It gives every American a chance at a high quality of life, for a longer time than is often available today. Single payer strengthens our economy, by keeping our workers healthier for longer. Single payer delivers better care at lower cost. Yes, there are risks with making the shift to single payer. There are challenges that must be overcome. But since when did we become a nation of cowards, afraid to embrace change, and shying away from challenges because doing the right thing is too hard? That is not who we are as a nation.
The political winds are shifting. We now see multiple high-profile politicians discussing single payer health care. Their views are painted as radical. But those views are not considered radical anywhere else in the world. If conservatives in Canada, the UK and other countries with similar lifestyles to our own accept and embrace single payer, what’s to stop us from doing so here at home? What do we have to fear? Better care? Lower costs? Seems to me that we are afraid of nothing more than our own shadows. We can be better, America. We can embrace a model of single payer that works better than any other country in the world, combining the best in care delivery that we have to offer, with a system that ensures all Americans have access to that high quality of care.
References
Christopher, A. (2016) Single payer healthcare: Pluses, minuses, and what it means for you. Harvard Health Publishing. Retrieved April 7, 2019 from https://www.health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means-201606279835
Ivers, N., Brown, A., Detsky, A. (2018) Lessons from the Canadian experience with single-payer health insurance. JAMA Internal Medicine Vol. 178 (9) 1250-1255.
PNHP (2019) About single payer. Physicians for a National Health Program. Retrieved April 7, 2019 from https://pnhp.org/what-is-single-payer/