SINGLE PAYER—IMPROVED MEDICARE FOR ALL:
WHAT IS IT? WHO WANTS IT?
What is Single Payer? There are many definitions of “Single Payer/ Improved Medicare for All” in public discourse. The two terms—”Single Payer,” and “Improved Medicare for All” –are used almost interchangeably, depending on which one better communicates to a particular audience the concept of “privately delivered, publicly funded” health care (much like Canada’s “Medicare”).
It is easy to feel confused about what Single Payer health care is. In fact, there are people profiting from the current exploitative (and inefficient) medical system who are working hard to keep us confused.
A group of activists in Utah doesn’t use either term, but named their group “Common Sense Health Care.” They don’t use the term, but instead list all the benefits of Single Payer plans:
No Financial Barriers — No Co-pays — No Deductibles — No Provider Networks — No Surprise Bills. In short “Nothing to prevent you from seeking the care you need.”
To clarify the relationship between the terms: “Single Payer” means that there is “one” (single) entity that processes all payments (such as in traditional Medicare, it is the government) rather than the current insurance “multiple-payer” system with hundreds of companies and thousands of policies that need to be accessed and processed, requiring almost as many billing clerks as beds in hospitals, and dedicated staff for health providers.
El-Sayed and Johnson (2021), in their comprehensive book, A Citizen’s Guide to Medicare for All gives this list of 6 “active ingredients that make M4A work” (pp. 103-109).
- Universal coverage
- Comprehensive coverage
- Pricing power
- Administrative efficiency
- Progressive financing
- Public accountability
The “Medicare for All” name was chosen because in surveys since the 1990s (e.g Kaiser studies), the term “Single Payer” had no clear meaning for the general public. By contrast, most people have heard of Medicare and understand a bit about it…and can’t wait to get on it. People are fearful of the unknown, and in this way, they can relate it to a known entity. The “expanded and improved Medicare for All” program being proposed builds on the established infrastructure and several generations of experience with our 50+ year-old “single payer” system.The term “expanded” means that it will cover everyone from cradle to grave, and “improved” means that it will cover more than original Medicare; it will cover all necessary medical services.
These pages attempt to show that “Improved and Expanded Medicare for All” is a much simpler and more cost-effective system than the patchwork of corporate plans that we have now. Medicare for All provides a better plan than even “platinum” or traditional Medicare currently provides. Furthermore, it is more just, and by preventing much of the medical debt burdening Americans today, it will lift an estimated 20% of our population out of poverty (Breunig, 2019). It is also a business stimulus, reducing the most difficult and unpredictable aspects of running a business.
In this section of the Toolkit, we have gathered…
- Overviews and talking points that we find helpful.
- The original articles by Himmelstein and Woolhandler in the New England Journal of Medicine in 1989 that introduced what a “national health program” could be, as well as a 2016 update.
- Glossary of Terms
- Universal Health Coverage. (UHC) Everyone has health insurance that provides meaningful access to care. Universal coverage could be provided by the government or a private company or some combination. The World Health Organization (WHO) provides this 90-second video on “What Does UHC Really Mean?”
- Single Payer. In a single-payer system, one entity pays all medical bills and sets prices for medical procedures. Canada has a single-payer system, with “public funding, but private delivery of services,” like traditional Medicare and most M4A proposals in the US. Britain has another type of single-payer system, a National Health Services with “public funding and public ownership of medical facilities and services,” like the VA system in the US.
- Managed care organization (MCO)–An organization that receives premiums from (or on behalf of) patients; provides subscriber access to a panel or network of doctors and hospitals. HMO handles financial aspects of medical practice and is responsible for containing costs (and can keep portion of what it “saves”). Legal in the US since 1973. Decisions about allocation of resources are made by multiple companies (depending on the number of MCOs); antithetical to “single payer”–where a “single entity makes global decisions” as in M4A programs.
- Accountable Care Organizations (ACO)–a form of managed care, physicians and hospitals are generally incentivized to work together to try to achieve greater integration of care and cost savings. As an “alternate payment plan” recognized by the Center for Medicare and Medicaid Services (CMS), ACOs keep a portion of money saved. (A longer glossary is available here).
ORIGINAL ARTICLES LAYING OUT A NATIONAL HEALTH PROGRAM FOR THE U.S.
- 2016 “Beyond the Affordable Care Act: A Physicians’ Proposal for Single Payer Health Care Reform” (by a 39-member working group of PNHP, including Himmelstein & Woolhandler).
- Defining terms associated with Health Care Reform
- From: LWV La Plata CO: Twelve-page booklet “Achieving Affordable, Accessible & Equitable Quality Healthcare for Every American.” In color, for printing front and back, collated. LaPlata_lwv-healthcare-booklet-2022.pdf
- From LWV-AZ (North West Maricopa County). Tri-fold brochure “Improved and Expanded Medicare for All FACTS”
- Q-and-A Handbook, “Facts vs. Myths for a Better Understanding of Medicare for All, Problems, Solutions, and How YOU Fit In,” 4-20-19 (21 pages)
- Comparison Sheet “Single Payer/Medicare for All vs Public Options”
- From LWV-MA (in conjunction with Western Mass Medicare for All) “What is Single Payer?” (printed to be folded in 4)