The Upcoming Healthcare Debate: Universal and Single Payer, Get Ready

Posted by Stephen Weinberg, MD FACC FACP

With the changing political landscape in Washington and the dismantling of the Affordable Care Act (Obamacare, ACA), it is becoming clear that a significant portion of the population will again be without affordable, comprehensive healthcare. This will likely spark a serious national debate as to what steps should be taken to resolve this situation.

There are many ways to think about this, but I believe it is important to decide at the outset whether you believe comprehensive healthcare is a right or a privilege.

 If you believe it is a right, with altruism as your guide, then we need to determine what services should be included and how to pay it. If you believe it is a privilege, then the marketplace should decide what coverage you purchase and how much you will pay for it. It is important to note that the US is only 1 of 5 countries in the world that has not ratified the UN 1966 Covenant of Social and Cultural Rights which stipulates that each country will provide for “The creation of conditions which would assure all medical service and medical attention in the event of sickness”. We are in the company of Cuba and 3 other third world countries. Additionally, the lack of comprehensive healthcare is the third leading cause of death in the US in the age group 50-64, behind heart disease and cancer.

If you believe healthcare is a privilege, then you should consider your own self interest as a driving force regarding your decision as to how to proceed. If it can be shown that it is less costly to provide universal comprehensive care, then you should support it. I will address this issue in detail in future posts.

There is a difference between “universal” healthcare and a “single payer” system. “Universal” means that all the people in your society are covered with comprehensive healthcare. The mechanism of paying for it can be with private health insurance, a public/governmental plan, or a combination. All industrialized countries in the world provide for “universal” coverage of their citizens. The payment mechanisms vary, as noted above, from country to country. The benefit of “universal” coverage is that you have a large risk pool so you can spread the costs over more people making it less costly for everyone.

This “universal” coverage doctrine is very different from a “single payer” system.

A “single payer” system means that all costs are paid for by one entity, typically the government, except for a small amount of self pay for copays and deductibles. Bear in mind that a “single payer” system could allow for payment of certain healthcare expenses in addition to the basics covered by the system. An example would be costs for elective cosmetic surgery not related to an illness or injury. The benefit of a “single payer” is lowered overhead in that you would not have duplication of resources of each payer which would include the buildings, computers, marketing, management and their salaries, lawyers, accountants, actuaries, shareholder profits, and the corporate jet. Additionally, another benefit is that there would be one set or rules that providers (physicians, hospitals, home care nursing, etc.) would have to follow making it less costly and more easily managed.

It is important, therefore, to not confuse the terms “universal” and “single payer”.

In future posts, I will discuss in detail the costs associated with our current system and compare them to those of a “universal” system and a “single payer”. In an effort to participate in what I believe will be the upcoming national discussions regarding healthcare, you need to have the information necessary to speak with authority and I will provide it. I believe you will be surprised about the actual costs and what can be accomplished with the current amount we are spending on healthcare.

Further information will be forthcoming very shortly. Stay tuned.