Now and then, talk about implementing a one-payer system in the United States enters public discourse.
Among patients, clinicians, and policy-makers this model is controversial. Advocates believe this system would increase healthcare access, reduce care disparities and reduce cost by utilizing economies of scale created by enrolling all Americans in the same insurance coverage. Opponents point to concerns about federal overreach, possible cost increases, and problems with healthcare quality.
Regardless of where you personally stand on the issue, understanding more about this model can help you learn more about the challenges facing today’s healthcare system and how policymakers are trying to respond.
A national single-payer system
According to a 2016 Gallup poll, 58 percent of Americans are open to the idea of a Federal payer system. There is a sizable number of Americans, in other words, who believe this is a better way to pay for healthcare. The model many proponents put forth is a Medicare-for-all type of system, where the existing framework of the Medicare Program would be adapted and expanded to provide coverage for all Americans. Healthcare providers would be encouraged to accept this form of public insurance.¹
In response, depending on how the system would be implemented, clinicians may choose to accept the single-payer insurance or offer concierge, cash-only care.
Another form of single-payer insurance would be state-based. In 2016, Colorado voters considered and ultimately rejected a proposal to create a state-wide single-payer health insurance system. The plan would have allowed private clinics and hospitals to operate but would create a taxpayer-funded insurance plan with a mandatory ten percent payroll tax split between employers and employees.²
Similar plans could be adopted in the future by individual states as an alternative to the ACA. These plans, if they are structured like the Colorado idea, would operate alongside public plans such as Tricare (insurance for people serving in the military and their families) and Medicare.
Medicaid, which is governed on a state-by-state basis, could disappear into the state’s public plan. State residents traveling outside the state would, in theory, continue to receive care paid for by their home state’s plan.²
Looking to the future
A change to a single-payer system would represent significant change inside a system that is now composed of many different payers and insurers. Private insurance, if such a system were created, could disappear or dramatically change, as would billing and EHR systems. It could increase demand for healthcare if more patients who previously did not have access to healthcare began obtaining services.
However, a single-payer system may also deny more services in the interest of cost-containment. Such a transition would likely take an extended period of time as the many different pieces of the current healthcare system would be fit together into a single funding source.²
Regardless of what happens, substantial changes to our healthcare system are likely to continue. Insurers are experimenting with different payment models while Medicare is experiencing change under MACRA and MIPS. New ways of funding healthcare are likely to remain a top priority of our healthcare system and therefore are a priority for clinicians to understand. Educating yourself and making your voice heard will help shape the future progress of healthcare funding.