Single-payer health care

From Wikipedia, the free encyclopedia

You have new messages (last change).

Single-payer health care is a system of paying for health care, in which a single government entity pays for all health care costs, usually from taxes. Private hospitals and doctors' practices may remain private. Single-payer health care is distinct from socialized medicine, in which hospitals are run by the government and medical professionals are employed by the government.

Contents

[edit] Intent

The "single payer" is the government, which serves the role of the insurance company. Although most universal health care systems are also single-payer systems, the "single-payer" part of the system is just the financing mechanism, not the health care delivery system.[1]

In countries like Canada that use a single-payer system, fees for doctors, hospitals and other providers are set by negotiations among doctors' associations, provincial or regional governments, and national governments. Global budgets eliminate the cost of billing individually for huge numbers of products and services. [2]

According to Marcia Angell, M.D., former editor of the New England Journal of Medicine, incremental changes in a free-market system are "doomed to fail."[citation needed] As the system becomes administratively more complex, the costs become greater, and more people fall through the cracks, argued Angell.

The U.S. health care system is the most expensive in the world on both a per capita basis and as a percentage of GDP[3], although standard indicators of health care quality are not the best in the world. The U.S. ranks 22nd in infant mortality between Taiwan and Croatia[4], 46th in life expectancy between Saint Helena and Cyprus[5], and 37th in health system performance between Costa Rica and Slovenia[6].

Angell, David Himmelstein, M.D., Stephanie Woolhandler, M.D., economist Paul Krugman, Ph.D.[7], and others have argued that insurance industry profit and administrative costs consume 30% of the health care dollar. [8] Insurance companies report a "loss ratio" of 85% or less for their health insurance premiums; this means that 85% of their premiums are paid to medical claims, and 15% are used for administrative expenses and profits.[citation needed] Health care providers must absorb the cost of staff time for dealing with the insurance companies, which is an additional cost of the insurance-based system.[citation needed] Medicare, Medicaid, and the Veterans Administration system spend 2% of their revenue on administrative costs.[citation needed] Under Medicare Choice, a privatized option for Medicare, the U.S. government pays a premium of 14% to free-market HMO providers.[citation needed]

[edit] Variations

Some single-payer systems would give patients free choice of providers and hospitals, and guarantee comprehensive coverage for all medically necessary procedures. All single-payer systems proposed in the U.S. would also include universal coverage with equal access by all. They would eliminate oversight by managed care reviewers, and return to the traditional doctor-patient relationship.[citation needed] [9]

Some writers have incorrectly described voucher plans as "single-payer plans"[10]

[edit] Types

One type of single-payer system, like the one in Great Britain, would have the government manage both the funding of the system and the health care facilities and providers, such as the doctors and hospitals.[citation needed]

Another type of single-payer system, like the one in Canada, would have the national government provide the funding, the provincial governments manage the hospitals, and have doctors in private practice contracting with the government for fee-for service payments.[citation needed]

Denmark, Sweden, Spain, Cuba and other countries employ single-payer financing of health care.[1] In the US, Medicare is considered to be a form of single-payer health care.[1] The major US single-payer proponents, such as Physicians for a National Health Program seek to establish a Canadian-style system.

[edit] Criticisms

Critics[citation needed] of government-run health care systems report unacceptable waiting periods, rationing, quality and consumer satisfaction in countries with single-payer systems, such as England and Canada. They claim that British and Canadian hospitals are underfunded, understaffed, lack the latest equipment, and are dangerous to patients, with a higher incidence of nosocomial infections.[citation needed]

Some critics compare the U.S. system to the Canadian system, and cite problems with the Canadian system. David Gratzer, M.D., of the Manhattan Institute argues[citation needed] that for example 5-year cancer survival in the U.S. is greater than in Canada [although comparisons in Health Affairs[citation needed] do not show clinically significant differences]. The Fraser Institute in Canada has published white papers in which the Canadian system compares unfavorably to the U.S. system.[citation needed] Some critics of the Canadian system report that Canadians travel to the U.S. for elective procedures, because of long waits for even urgent surgeries.[citation needed] However, the infant mortality and life expectancy in Canada are equal to that in the U.S.[citation needed]

Others have compared the British health care system to the U.S., both for medical outcomes and for cost[citation needed], in the British Medical Journal[citation needed] and elsewhere[citation needed].

Some critics[citation needed] argue that a single-payer system would reduce medical innovations and advances and drive American medicine into obsolescence. It would lower revenues of doctors, medical institutions, drug companies and medical device companies. Global budgets and government controls would prevent expenditures for equipment and facilities.

Some critics[citation needed] argue that a single-payer health care would be unethical, because much of the cost of health care relates to lifestyle choices (such as smoking, diet, amount of exercise, alcohol and drug intake), and so some people would pay extra taxes for the poor lifestyle choices made by others.

Finally, some critics, including many politicians[11] and advocacy groups[citation needed] argue that whether or not a single payer system would be better, it would be politically impossible in the U.S. [12]

[edit] Polls

Public polling has given mixed signals as to the general opinion of the American public.

NBC News/Wall Street Journal Poll Jan. 17-20, 2007 N=1,007 adults nationwide. MoE ± 3.1

Within the past year, the governors of Massachusetts and California have put forward plans to require all residents in their states to have health insurance coverage. For example, the plan in Massachusetts would require residents with higher incomes to pay for coverage and state funding that would be used to help cover residents with lower incomes. Do you think it is a good idea or bad idea to do this for the entire country?

53% - Agree
40% - Disagree
7% - Unsure


Gallup Poll Nov. 9-12, 2006 N=1,004 adults nationwide. MoE ± 3 (for all adults)

Which of the following approaches for providing health care in the United States would you prefer: replacing the current health care system with a new government run health care system, or maintaining the current system based mostly on private health insurance? 39% - Replace
51% - Maintain
10% - Unsure


"Washington Post-ABC News Poll: Health Care," October 20, 2003:

3. And are you generally satisfied or dissatisfied with the total cost of health care in this country? Would you say you are very (satisfied/dissatisfied) or somewhat (satisfied/dissatisfied)?

21% - Satisfied (7% very, 14% somewhat)
78% - Dissatisfied (24% somewhat, 54% very)

37. Which of these do you think is more important: (providing health care coverage for all Americans, even if it means raising taxes) or (holding down taxes, even if it means some Americans do not have health care coverage)?

80% - Providing health care for all Americans
17% - Holding down taxes
3% - No opinion

38. Which would you prefer - (the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance); or (a universal health insurance program, in which everyone is covered under a program like Medicare that's run by the government and financed by taxpayers?)

32% - Current
62% - Universal
2% - No opinion

39. (IF UNIVERSAL, Q38) Would you support or oppose a universal health insurance program if it limited your own choice of doctors?

56% - Support
42% - Oppose
2% - No opinion

40. (IF UNIVERSAL, Q38) Would you support or oppose a universal health insurance program if it meant there were waiting lists for some non-emergency treatments?

63% - Support
34% - Oppose
3% - No opinion

[13] cited and reformatted in [14]

[edit] California proposals

In 2006, the state legislature of California passed SB 840, The Health Care for All Californians Act, a single payer health care system, but Governor Arnold Schwartzenegger (R) vetoed the bill. California State Senator Sheila Kuehl has reintroduced the bill.[15][16]

[edit] References

  1. ^ a b c Chua, Kao-Ping. "Single Payer 101". February 10, 2006.
  2. ^ Physicians for a National Health Program. "What is Single Payer?".
  3. ^ "Expenditure on Health", OECD Health Division. Retrieved on 2007-03-13.
  4. ^ "Rank Order - Infant Mortality Rate", CIA World Factbook. Retrieved on 2007-03-13.
  5. ^ "Rank Order - Life Expectancy at Birth", CIA World Factbook. Retrieved on 2007-03-13.
  6. ^ "The World Health Report 2000", World Health Organization. Retrieved on 2007-03-13.
  7. ^ "The Health Care Crisis and What to Do About It," By Paul Krugman, Robin Wells, New York Review of Books, March 23, 2006[1]
  8. ^ [2] Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003
  9. ^ Proposal: Components of A United Health System. [3][Dead link]
  10. ^ A Health Care Plan So Simple, Even Stephen Colbert Couldn’t Simplify It, By ROBERT H. FRANK, New York Times, February 15, 2007 [4]Fuchs [5]
  11. ^ [6] Timid ideas won't fix health mess, By Marie Cocco, Sacramento Bee, February 10, 2007
  12. ^ Emanuel EJ, Fuchs VR. Health care vouchers -- a proposal for universal coverage. N Engl J Med 2005;352:1255-1260. [Free Full Text after free signup] [7]
  13. ^ [8] "Washington Post-ABC News Poll: Health Care," October 20, 2003
  14. ^ [9]America's HealthTogether
  15. ^ California Healthcare for All
  16. ^ California Onecarenow.org

[edit] See also

[edit] External Sources

  • Institute of Medicine Committee on the Consequences of Uninsurance. Hidden costs, value lost: uninsurance in America. Washington, DC: National Academies Press, 2003. [10] Frequently-cited source.
Retrieved from "http://en.wikipedia.org../../../s/i/n/Single-payer_health_care.html"