ENG: Single-payer health care is a model for operating the U.S. health care system by arranging the payment of services to doctors, hospitals, and other health care providers from a single source established and managed by government. It is a way to deliver near-universal or universal health care. The administrator of the fund could be the government but it could also be a publicly owned agency regulated by law. Australia's Medicare, Canada's Medicare, and healthcare in Taiwan are examples of single-payer universal health care systems.
The term single payer system does not imply a socialized medicine system. A socialized medical system is one "in which all health personnel and health facilities, including doctors and hospitals, work for the government and draw salaries from the government," an example being the U.S.
Veterans Administration, while U.S. Medicare is a single payer system which is not socialized medicine.
In Canadian Medicare, which is a single-payer insurance available to all citizens, doctors may work in private practices or for public or private hospitals, each of which is in turn paid by government health insurance. Under the United Kingdom's National Health Service, which also uses a universal single-payer fund, the public owns the health systems and facilities. The term single-payer thus only describes the funding mechanism - referring to health care being paid for by a single public body - and does not specify the type of delivery, or who doctors work for.
As regards health care reform in the United States in general, it is the only high-income industrialized country in the world that does not have some version of national universal public health insurance; although every state has a public health care system of some kind, they do not provide guaranteed universal coverage. The majority of physicians in the United States are in favor of national health insurance system.
A recent study published in 2008 in Annals of Internal Medicine, a leading medical journal, showed 59% of physicians “support government legislation to establish national health insurance,” while 32% oppose it and 9% are neutral. This represented an increase of 10 percentage points as compared with a similar survey in 2002 in which support for such legislation stood at 49% of physicians. Among the general U.S. public, recent polling ratings for single-payer are apparently dependent on wording, ranging from 49% to 65%.
Proponents and support
Physicians for a National Health Program the American Medical Student Association and the California Nurses Association are among those that have called for the introduction of a single payer health care program. In Congress, Rep.
John Conyers, Jr. (D-MI) has repeatedly introduced The United States National Health Care Act (HR 676). As of August 2008, HR 676 had 91 co-sponsors.
The issue has often been debated and there are signs that the American public has warmed to the idea. A CBS News/New York Times poll published in February 2009 reported that 59% say the government should provide national health insurance (up from 40% thirty years earlier) A study published in the Annals of Internal Medicine concluded that 59% of physicians "supported legislation to establish national health insurance" while 9% were neutral on the topic, and 32% opposed it.
Supporters such as Dennis Kucinich and the California Nurses Association regard the profit motive in health care as the biggest threat in health care because it leads to for-profit insurance companies applying high deductibles, high co-pays, and refusing to fund pre-existing conditions. Rescinding policies or denying care by private insurance corporations after perhaps a lifetime of premium payments, is in their view an abuse of corporate power against people who are sometimes too ill to stand up for their rights.
In one publicized case, a nurse who had had health insurance was denied insurance when she was diagnosed with cancer. The "everyone in" and "democratic control" over a public financing arrangement like single-payer would, they argue, end such abuse, and would ensure fairness.
Opponents and criticisms
Several criticisms have been leveled against the idea of changing the U.S. health care system to a single-payer system. Some proponents argue that perhaps the largest obstacle is a lack of political will. While polling data indicate that U.S.
citizens are concerned about health care costs and think the system needs reform, most are generally satisfied with the quality of their own health care. According to a Joint Canada/United States Survey of Health in 2003, 86.9% of Americans (though only 63.6% of uninsured Americans) reported being "satisfied" or "very satisfied" with their health care services, compared to 83.2% of Canadians. In the same study, 93.6% of Americans reported being "satisfied" or "very satisfied" with their physician services, compared to 91.5% of Canadians.
Some medical researchers say that patient satisfaction surveys are a poor way to evaluate medical care. Researchers at the RAND Corporation and the Department of Veterans Affairs asked 236 elderly patients at 2 managed care plans to rate their care, then examined care in medical records, as reported in Annals of Internal Medicine. There was no correlation. "Patient ratings of health care are easy to obtain and report, but do not accurately measure the technical quality of medical care," said John T. Chang, UCLA, lead author. It should also be pointed out that according to the above Joint Canada/United States Survey of Health in 2003 (a telephone survey of households, using randomly dialed land lines), "approximately 11% of Americans do not have health insurance." However, the US Census Bureau reported a far larger number of Americans, 15.7%, as not having health insurance during the same time period.
For this reason, some U.S. reformers argue for other, more incremental changes to achieve universal health care, such as tax credits or vouchers. However, supporters of a single-payer system, such as Marcia Angell, M.D., former editor of the New England Journal of Medicine, assert that incremental changes in a free-market system are "doomed to fail."
Leif Wellington Haase argues that converting to a single-payer system could be a radical change and might create administrative chaos.
According to CBO’s and JCT’s assessment, enacting H.R. 3200 would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period.
Health care in the United States - The United States is the only industrialized nation that does not have a universal health care system. The government directly covers 27.8% of the population through health care programs for the elderly, disabled, military service families and veterans, children, and some of the poor, through Medicare, Medicaid, SCHIP, and TRICARE.
Health care reform in the United States - The debate over health care reform in the United States centers on questions of a right to health care, access, fairness, the quality achieved for the high sums spent, and the sustainability of expenditures that have been rising faster than the level of general inflation and the growth in the economy.
Health care reform debate in the United States
Health care in Canada - Health care in Canada is funded and delivered through a publicly-funded health care system, with most services provided by private entities.
Canadian health care in comparison
Two-tier health care - A term used by some to describe a situation that arises when there is a basic health care system financed by government providing medically necessary but perhaps quite basic health care services, and a secondary tier of care for those with access to more funds who can purchase additional health care not covered by the publicly financed system or which permits better quality or faster access.
Universal health care - Health care accessibility for all eligible residents of a political region, and often covers medical, dental and mental health care. Typically, costs are borne in the majority by government-funded programs.
August 20, 2009