What is a single payer healthcare system?

photo by Scott M, filckr.com

photo by Scott M, filckr.com

A single payer healthcare system simply means that there is only one health insurance provider (usually the government) and all citizens healthcare is provided through the single payer.  We have a single payer program in the United States called Medicare.  Many would argue that Medicare has been quite successful and should be expanded to cover all US citizens while others argue that Medicare has been a nightmare and would cost too much to implement for all citizens.

There are certainly advantages to a single payer system.  First, all citizens would have access to healthcare under the single payer.  There would be no more debate about the uninsured and there would be practically no bankruptcy from healthcare costs.  This is a big deal as healthcare is the #1 reason for bankruptcy in the United States.  The cost of healthcare would likely decrease.  A single payer system can leverage the power of controlling payments for the entire country.  Therefore, drug costs could be negotiated to a much lesser cost, hospital costs would be standardized and lowered, treatment regimens could be initiated in an attempt to standardize care and optimize costs.

However, there are plenty of disadvantages to a single payer system.  As seen in most countries with a single payer system care is rationed.  Meaning “elective” procedures and surgeries are often delayed or denied.  Not all treatments are covered or offered and results in patients who can afford to travel and pay for healthcare with cash seek care in places like the United States.  The government would have access to each individuals health information which many see as an invasion of privacy and gives the government far too much control over the lives of the citizens.  Competition within medicine would likely decrease as reimbursements decrease which could decrease innovation in medical care and decrease the number of qualified/talented physicians and researchers.  Many medical decisions would likely be driven by government protocols which detracts from the patient-physician relationship.  Physicians become more like protocol driven technicians and less like critically thinking doctors.  Lastly, taxes increase.  Instead of health insurance premiums going to private insurance companies the payments will go to the government in the form of taxes.  That means if you feel you are paying too much for healthcare you cannot shop around for a different plan that would cost less.  The government  could force you to pay whatever they feel is fair as long as you file taxes.

The bottom line is that healthcare is expensive and complicated and it is difficult to develop a system that covers the needs of 3oo+ million people.  Whether you support a private healthcare system that depends on competition to drive quality care at an affordable cost or a single payer system that covers all citizens basic needs while rationing care there will always be a good argument for the opposing view.  The United States has held on to a private system while most of the rest of the world has changed to a single payer system.  Both systems are flawed, both are expensive, and both need to be improved.

 

About the Author

I am Joshua Lewis, MD, the creator of Discussing Healthcare, LLC and a board certified Emergency Physician who currently practices in the Phoenix, Arizona area. I hope you will gain meaningful insight into our healthcare system through the information provided by Discussing Healthcare. Thank you for your interest and I encourage you to contribute by calling, emailing, or leaving comments on the website.

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