EDUCATION
September 12, 2017

9 Things You Should Know About Single-Payer Healthcare

By Amy Blitchock

The U.S. just got one step closer to Single-Payer Healthcare.  Two weeks ago, Sen. Kamala Harris became the first to co-sponsor a “Medicare For All” bill proposed by Sen. Bernie Sanders.

The bill itself is set to be introduced in Congress this week and though it appears unlikely to gain bipartisan support, it will bring the debate for Single-Payer Healthcare to the national stage.

Here’s what you need to know about single-payer healthcare and how it might affect your job as a nurse.

1. The Concept Is Gaining Popularity

Until recently, the idea of a single-payer system was largely regarded as a pipe dream that had no chance of becoming a reality. However, there has been a significant shift and Democrats are realizing that supporting the bill may even be a smart political move.

In fact, some pundits argue that any viable 2020 presidential candidate will need to show support for the single-payer bill now.

Recently, a handful of prominent politicians have come out in support of Sanders’ bill,  including Senators Max Baucus (D-Mont), Elizabeth Warren (D-Mass), Kamala Harris (D-Calif), and Sheldon Whitehouse (D-Rhode).

This move paves the way for other politicians to support a single-payer system.

2. Trump Appears To Support It

In 2000, before becoming president and while he was toying with the idea of running as a Reform Party candidate, Trump was a vocal supporter of Single-Payer healthcare. In his book, "The America We Deserve," Trump stated the following:

"We must have universal health care. Just imagine the improved quality of life for our society as a whole."

"The Canadian-style, single-payer system in which all payments for medical care are made to a single agency (as opposed to the large number of HMOs and insurance companies with their diverse rules, claim forms and deductibles) … helps Canadians live longer and healthier than Americans."

A recent article in the Washington Post also highlighted several other instances in the last two years which indicate that Trump may be leaning towards a single-payer system.

3. This Isn’t The First Time Single-Payer Healthcare Has Been Proposed

A similar bill, HR 676, was introduced in the House of Representatives in January and since then received substantial support from 117 legislators. The parallel bill from Sanders could give Single-Payer a significant boost.

Single-payer systems have been proposed in several states. Most recently, in June of 2017, California Assembly Speaker Anthony Rendon shelved a proposed bill that would have established a single-payer healthcare system in the state. Under the bill, the state would have taken on the responsibility for the medical costs for all of its residents.

While the bill is currently stalled, the debate over whether the single-payer system is the right solution for a healthcare system that is completely overwhelmed and underfunded is gaining momentum.

In California, nurses have been advocating for single-payer healthcare for some time.  They’ve seen first-hand the effect from a lack of preventative healthcare. Many believe removing private businesses from the healthcare system and shifting the financial burden to the government would reduce costs and allow everyone to receive healthcare. 

While this sounds like a worthy goal, there is major opposition to overhauling the existing system.

The majority of California residents support a single-payer system, but only as long as taxes aren’t raised. As a result, politicians who are worried about re-election are hesitant to push through any bill that increases taxes. Instead, California’s legislative leadership simply decided to stall the bill in order to avoid controversy and any risky political moves. 

Activists are making sure that just because the bill has been stalled, doesn’t mean that it is forgotten. Dale Fountain, leader of the Facebook group "Enact Universal Healthcare for California," is introducing initiatives to the ballot that would require the Legislature to act on the bill and prevent them from continuing to kick the vote down the road. 

Events in California may foreshadow what Americans can expect in the coming weeks as the Medicare For All bill is introduced to Congress. 

10 other states that have also proposed single-payer systems include:

  • Colorado
  • Hawaii
  • Illinois
  • Massachusetts
  • Minnesota
  • Montana
  • New York
  • Oregon
  • Pennsylvania
  • Vermont

4. Single-Payer Refers to Funding Only

While many people tend to think of single-payer systems as being synonymous with universal healthcare, single-payer is one path to funding healthcare for everyone. Single-payer simply refers to the fact that the government would be solely responsible for paying for universal care. Hospitals and doctors remain private entities while the government footing the bill.

Also, countries around the world have achieved universal healthcare through different funding models that don’t put the sole financial responsibility on the government.

For example, in industrialized nations, such as Germany, France, and Japan, universal healthcare is funded by a combination of public and private sources. In some cases, employers are mandated by law to contribute to non-profit “sickness funds.” Ultimately, the goal is to provide better access to healthcare without putting a financial burden on patients. This results in healthier residents who actively engage in preventative and follow-up care. Over 58 countries around the world provide universal healthcare. The U.S. is notably absent from that list.

5. Hospitals Are Still In Charge Of Care

Essentially, one government agency is responsible for funding healthcare for everyone while private facilities would be responsible for actually providing care.

In theory, the funding would come in large part from the savings the government would experience by replacing a faulty system with a more efficient approach that is not profit driven. Some lawmakers also want to help fund the program by instituting minor tax increases that are income-based. 

6. There Are Benefits To A Single-Payer System

The biggest benefit of a single-payer system is that it would provide every American with equal access to healthcare and remove any barriers to receiving care. Every person could seek medical attention without having to worry about medical bills. No one would be turned away or have to pay insurance premiums. This would mean that Americans would have more money to save and spend in other ways and they could enjoy a better quality of life.

A non-profit system would also reduce the overall cost of care. Currently, medical facilities, insurance companies, and a little-known organization called the AMA / Specialty Society Relative Scale Update Committee are in charge of determining market prices for healthcare. The AMA committee is a private, invitation only organization that uses complex formulas to determine recommended prices. As a result, there is no consistency when it comes to pricing and the entire system is motivated by financial incentives rather than patient outcomes. A single-payer approach is designed to reduce inflated costs and create uniform and transparent pricing.

7. Not Everyone Supports A Single-Payer System

The main argument against instituting a single-payer system is that it will result in more government bureaucracy. Those opposed to putting the government in charge of funding healthcare don’t trust that such a large organization can effectively execute funding while also preventing corruption and misappropriation of money. They also argue that removing financial incentives will bring innovation to a halt because conducting research and developing new treatments and medicines wouldn’t be lucrative pursuits.

Since the inception of the United States, Americans have been trying to find a balance between limiting government and providing social programs that support citizens in times of need. While other countries tend to take a more socialist approach to distributing resources, Americans don’t view healthcare as the responsibility of the government. As a highly individualistic society, the burden of healthcare is put on the people. However, this philosophical approach tends to break down when people are faced with the realities of the healthcare system whether on a personal or professional level.

In addition, private insurance companies represent a powerful lobbying force that is working hard to protect their interests. In 2009, when the Affordable Care Act was being hotly debated, insurance companies spent $100 million to try and influence the political process and make sure that their business wouldn’t be negatively affected by the new bill. In total, interest groups from a variety of sectors spent $1.2 billion in lobbying efforts on the ACA alone. With some many external forces, it is hard to imagine that single-payer healthcare plans and other alternatives to the existing system have a fair opportunity to be debated in earnest.

8. The Nursing Community Is Split

The majority of nursing organizations support a single-payer system and have been advocating for major healthcare reform at both the state and federal level. As the Nurses Association in New York State testified: “We see New Yorkers who rely on the emergency department as their primary entry point for care. We see New Yorkers who delay treatment until they are so ill, they must lose work time and be hospitalized. Our current healthcare system has failed to adequately prevent disease, promote health, protect our children, the disabled and the elderly. As nurses, it is our duty to support legislation that would remedy this.” 

On the other hand, some people within the nursing community are afraid that healthcare reform will negatively affect their salaries and career opportunities while also weakening their political power. However, these fears have not been realized in other single-payer systems. For example, studies have found that Canadian nurses were not put at a professional disadvantage under the single-payer system. It turns out that the source of healthcare funding has no notable effect on the field of nursing.

It is difficult to predict how a single-payer system would affect the day-to-day lives of nurses. In theory, more people would be seeking care at the first signs of a problem while also participating in preventative care. That would mean less emergency room traffic and more demand for nurses in primary care facilities. Currently, the job growth rate for RNs is 16% and it is highly unlikely that healthcare reform would have any effect on the continuing need for qualified nurses. 

9. There's Still A Long Road Ahead

This week, Bernie Sanders plans to introduce his "Medicare for all bill" in the Senate. Sanders and his supporters argue that healthcare should be a right and not a privilege. 

With Republicans controlling every branch of government, it’s highly unlikely that this Democrat-supported bill will become law anytime soon. However, it has revived the conversation and lays the groundwork for the cultural shift needed for it to ever successfully pass.

As more Americans continue to struggle with the cost of healthcare, the idea of implementing a single-payer system has already gained traction. This first step will create a more informed, national debate.  

Photo Credit: "US Capitol Building", © 2006 Rob Crawley, Flickr | CC-BY | via Wylio

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