Single-Payer Would Cover Everybody

Unfortunately, the current system is working as intended. The for-profit health insurance industry is designed to enrich shareholders and executives, not to ensure that everyone has coverage. In fact, private insurance companies have a strong incentive to deny coverage to people who are sick or are likely to be sick because covering them simply is not profitable. In contrast, a single-payer system would be designed to make sure that everybody gets the health insurance that they need. Most people recognize that healthcare is a human right and that everybody deserves coverage. Despite the best efforts of insurance companies and corporate-aligned politicians to discredit government involvement in healthcare, six out of ten Americans still believe that the government has a responsibility to ensure that everyone has coverage.5

In addition to fulfilling a basic human right, universal coverage also promotes social equity. Racial and ethnic discrimination is woven into the current healthcare system. African American, Hispanic, and Indigenous communities are far more likely to be denied coverage.6This can only be effectively addressed by ensuring that everyone is guaranteed healthcare. Additionally, providing universal coverage will help level the playing field between workers and employers. Under the current system, being fired or quitting one’s job usually means losing health insurance, and employers wield this power to discourage workers from unionizing or engaging in collective bargaining. Under a single-payer system, employers would no longer exercise control over their employees’ ability to receive medical care, empowering workers to demand fair treatment.

Single-Payer Would Cover Everything

A single-payer system would automatically include dental and vision care, coverage which is often not provided with private plans. Additionally, a single-payer system would cover medical services that are essential to maintaining reproductive health. Under the current system, women who are uninsured or underinsured cannot safely access abortion services. A single-payer system would eliminate this problem, by guaranteeing every woman access to reproductive health care. Finally, single-payer would cover preventive care. With the current for-profit healthcare system, patients routinely forgo important checkups, screenings, and counseling appointments, because those services are expensive. This often allows illnesses to deteriorate, becoming more harmful to the patient’s health and more expensive to ultimately treat.

Single-Payer Would Cost Less Money

Health insurance companies—and the politicians they pay—often claim that a single-payer system would require us to raise taxes. In fact, all but the very richest Americans would wind up spending substantially less money under single-payer. Everybody who is not covered by government-administered programs (like Medicare and Medicaid) must rely on the private market to obtain health insurance. Most get coverage through their employers and the rest receive it through individual plans. But neither of these options is free. Employers fund their company’s insurance plans by deducting the money from their employees’ paychecks and individual plans are funded by premiums sent directly to the insurance company.

This effectively creates a health insurance tax. Anyone who wants coverage, but doesn’t receive it from a government-administered program, is forced to pay private insurance companies. This tax is extremely regressive because insurance premiums are not scaled up or down based on wealth. The Affordable Care Act provides some limited subsidies to make insurance less expensive for low-income individuals, but the working class still winds up spending a vastly greater percentage of its income on health insurance than the ultra-rich. Under a single-payer system, the current, regressive healthcare tax would disappear. Instead, everybody’s insurance would be funded through a progressive tax collected by the government which would be scaled according to wealth. The system would be funded by raising taxes on the super-rich, lowering costs for everyone else.

Healthcare in America is so expensive partly because the cost of prescription drugs and medical devices are set by the market. Companies know that they can charge exorbitant prices for healthcare products and services because sick people will need to buy them anyway. This is why a vial of insulin in the US often costs around $300, whereas the same product in Canada costs $20.7 Similarly, it is why an MRI in the US costs $1,119 and the same scan in Australia costs $215.8 Health insurance companies have to pay the inflated costs of prescription drugs and medical devices. They pass those costs onto us. Under a single-payer system, companies that want to sell healthcare products and services (like insulin or MRI scans) would have to negotiate their prices with the government. And the government could use that power to force companies to charge substantially less money. We know this strategy is effective because it is precisely how many other countries have achieved much lower healthcare costs.


*Reprinted with Permission from: 

1 Kaiser Family Foundation, State Health Facts: Health Insurance Coverage of the Entire Population (2018).

2 Robin Cohen, Michael Martinez, and Emily Zammitti, Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey (Aug. 2018).

3 John Tozzi, Health Insurance Costs Surpass $20,000 Per Year, Hitting a Record (Sep. 2019).

4 Dan Witters, Millions in U.S. Lost Someone Who Couldn’t Afford Treatment (Nov. 2019).

5  Jocelyn Kiley, Most Continue to Say Ensuring Health Care Coverage is Government’s Responsibility (Oct. 2018).

6 Samantha Artiga, Kendal Orgera, and Anthony Damico, Changes in Health Coverage by Race and Ethnicity Since Implementation of the ACA (Feb. 2019).

7 Julia Belluz, The Absurdly High Cost of Insulin, Explained (Nov. 2019).

8 Sarah Kliff, The Senate Bill Does Nothing to Fix America’s Biggest Health Care Problem (Jun. 2017).

9 Margot Sanger-Katz, The Difference Between a ‘Public Option’ and ‘Medicare for All’ (Feb. 2019).

The Current System is Broken

Our healthcare system is immensely dysfunctional. In Rhode Island alone, well over forty thousand people lack health insurance.1 Those who do have insurance are saddled with enormous out-of-pocket costs. Nearly half of all people under sixty-five are enrolled in “high-deductible” plans, with an annual deductible of at least $1,350 for an individual and $2,700 for a family.2 The cost of premiums has been rising steadily for decades, vastly outpacing wage growth.3 People routinely die because they cannot afford the healthcare they need. Thirty-four million American adults report knowing at least one friend or family member who has died in the last five years because they were unable to pay for necessary medical treatment.4

A Public Option is a Bad Compromise

A “public option” would create a government-administered health insurance plan to compete in the market with private plans.9 Employers and individuals could buy into the public option by paying premiums directly to the government. There are serious problems with a public option. Most importantly, it would not result in universal coverage. Because buying into the public option would require recipients to pay premiums, copays, and deductibles, some people will be unable to afford it. Even those who can afford it may choose to forgo coverage, assuming they won’t get sick. The whole purpose of health insurance is to spread risk and costs between sick people and healthy people. If healthy people can choose not to buy the public option, the remaining pool of people who do buy it will be disproportionately populated with sick people who cost more money to insure, forcing the government to raise premiums. Furthermore, private insurance company lobbyists will undoubtedly pressure politicians to dismantle the public option or weaken its coverage, because doing so would make private plans comparatively more attractive. Finally, with a public option, the government would not control enough of the insurance market to effectively negotiate lower prices for medical devices, healthcare services or prescription drugs.

Healthcare Justice*

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