Overview of Single Payer / “Medicare For All”

“Although health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to singlepayer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.”

Source: Alison P Galvani, Alyssa S Parpia, Eric M Foster, Burton H Singer, Meagan C Fitzpatrick, Improving the prognosis of health care in the USA, The Lancet, Volume 395, Issue 10223, 2020, Pages 524-533, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(19)33019-3.

“An oft-proposed alternative to the contemporary multi-payer system is single-payer, also referred to as Medicare for All. Key elements of single-payer include unified government or quasi-government financing, universal coverage with a single comprehensive benefit package, elimination of private insurers, and universal negotiation of provider reimbursement and drug prices. Single-payer as it has been proposed in the US has no or minimal cost sharing.”

Source: Cai C, Runte J, Ostrer I, Berry K, Ponce N, Rodriguez M, et al. (2020) Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses. PLoS Med 17(1): e1003013. https://doi.org/ 10.1371/journal.pmed.1003013

“Although single-payer systems can have a variety of different features and have been defined in many ways, health care systems are typically considered single-payer systems if they have these four key features:

“• The government entity (or government-contracted entity) operating the public health plan is responsible for most operational functions of the plan, such as defining the eligible population, specifying the covered services, collecting the resources needed for the plan, and paying providers for covered services;

“• The eligible population is required to contribute toward financing the system;

“• The receipts and expenditures associated with the plan appear in the government’s budget; and

“• Private insurance, if allowed, generally plays a relatively small role and supplements the coverage provided under the public plan.”

Source: Congressional Budget Office, Key Design Components and Considerations for Establishing a Single-Payer Health Care System. May 2019.

“‘Single-payer’ is often confused with other concepts or goals, such as universal coverage, administrative efficiency, and better affordability. Critics and proponents of single-payer health care often describe it as a Beveridge-style, socialized system where the government pays for services, operates hospitals, and employs physicians and other health care professionals (68, 69). However, according to Liu and Brook (70), the term ‘single-payer’ originated to differentiate the Canadian system of government financing and private delivery from that of the United Kingdom, where, for the most part, the government is responsible for both, and now is often used to describe financing by a single public entity irrespective of delivery type. Single-payer systems do not necessarily prohibit private insurance. For example, many Canadians have private insurance to cover supplemental benefits not included among guaranteed benefits, such as prescription drugs (71). In Denmark’s single-payer system, 39% of people have private supplemental insurance to finance such services as physical therapy (72). Other countries permit the sale of complementary coverage for faster access to covered benefits or acute care services from private sector professionals (73).”

Source: Crowley R, Daniel H, Cooney TG, et al, for the Health and Public Policy Committee of the American College of Physicians. Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care. Ann Intern Med. 2020;172:S7–S32. doi: doi.org/10.7326/M19-2415

In a research article published in the International Journal of Health Planning and Management, Hagenaars et al. identified the following OECD member nations as having single payer systems:
Government schemes with residence based entitlement (mostly national health service) – Australia, Canada, Denmark, Iceland, Ireland, Italy, Latvia, Portugal, Spain, Sweden, United Kingdom
Compulsory Social Health Insurance – Greece, Hungary, Korea, Luxembourg, Poland, Slovenia, Estonia

Source: Hagenaars, LL, Klazinga, NS, Mueller, M, Morgan, DJ, Jeurissen, PPT. How and why do countries differ in their governance and financing‐related administrative expenditure in health care? An analysis of OECD countries by health care system typology. Int J Health Plann Mgmt. 2018; 33: e263– e278. doi.org/10.1002/hpm.2458

Selected Resources On Single Payer / “Medicare For All”
A. P. Galvani PhD, et al., The Lancet, 2020: Improving the prognosis of health care in the USA

Cai et al, PLOS Medicine, 2020: Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses

Congressional Budget Office, 2019: Key Design Components and Considerations for Establishing a Single-Payer Health Care System

Political Economy Research Institute, 2018: Economic Analysis of Medicare for All

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated March 16, 2021 by Doug McVay, Editor.