Single-payer health care is an American term describing the payment for doctors, hospitals and other providers for health care from a single fund. The Canadian health care system and Medicare in the U.S. for the elderly are single-payer systems. Canadas health care system is a publicly funded health care system, with most services provided by private entities. ... President Johnson signing the Medicare amendment. ...

According to the National Library of Medicine, a "Single-Payer System" is

An approach to health care financing with only one source of money for paying health care providers. The scope may be national (the Canadian System), state-wide, or community-based. The payer may be a governmental unit or other entity such as an insurance company. The proposed advantages include administrative simplicity for patients and providers, and resulting significant savings in overhead costs. (From Slee and Slee, Health Care Reform Terms, 1993, p106) Year introduced: 1996^[1]

Some writers argue that the single payer is the government,^[2] but the preceding definition as well as some single-payer proponents in the U.S. leave the government's role open to interpretation.

Single payer is one alternative proposed for reforming the U.S. health care system. Proponents argue that it would provide universal coverage with at least the same quality and lower costs. Critics argue that single payer would harm quality and innovation and advocate tax code incentives^[3] and free market approaches instead. ^[4] (This article is about political movements affecting the delivery of health care and health care systems. ... Health care in the United States is provided by many separate legal entities. ... A free market is an idealized market, where all economic decisions and actions by individuals regarding transfer of money, goods, and services are voluntary, and are therefore devoid of coercion and theft (some definitions of coercion are inclusive of theft). Colloquially and loosely, a free market economy is an economy... This article or section is in need of attention from an expert on the subject. ...

The term single-payer is often used in the U.S. to distinguish systems paid from a single source with other systems of universal health care in which the government has a higher degree of control, up to and including administering hospitals and employing doctors and staff. (See socialized medicine.) Under single payer, doctors' practices and hospitals may remain private and negotiate for payments with the government. Socialized medicine or state medicine or Universal Health Care is a term used in the United States to describe health care systems which operate by means of government regulation and subsidies derived from taxation. ...

Types and variations

Canada is an example of single-payer health care.^[2] The national government provides part of the funding, provincial governments manage the hospitals (and provide the brunt of the funding), and doctors in private practice contract with the government for fee-for-service payments. Many Canadian citizens have supplemental health insurance, which covers expenses not covered by Canadian Medicare. Fees for doctors, hospitals and other providers are set by negotiations among doctors' associations, provincial or regional governments, and the national government. Global budgets eliminate the cost of billing individually for huge numbers of products and services.^[5] The term medicare (in lowercase) (French: assurance maladie) is the unofficial name for Canadas universal public health insurance system. ...

The United States and Australia also have single-payer health insurance programs named Medicare; however, Australia's program provides universal health insurance, while U.S. Medicare is only for senior citizens and the disabled.^[2][6] Government is increasingly involved in U.S. health care spending, paying about 45 percent of the $2.2 trillion the nation spent on medical care in 2004.^[7] Medicare Australia is an agency of the Australian Government that administers health-related programs including Medicare, the Pharmaceutical Benefits Scheme (PBS), and others. ... President Johnson signing the Medicare amendment. ... Health care in the United States is provided by many separate legal entities. ...

Scotland, Norway, and Finland have implemented single payer health insurance. Each country's citizens share risk in a common pool. ^[8]

According to Princeton University health economist Uwe E. Reinhardt, single-payer systems such as Medicare, Medicaid and the Canadian system are properly called "social insurance" systems, because they're coupled with a largely private delivery system.^[9]

The Veterans Administration is a single payer system and provides excellent quality, said Reinhard. In a peer-reviewed paper published in the Annals of Internal Medicine, researchers of the RAND Corp. reported that the quality of care received by Veterans Administration patients scored significantly higher overall than did comparable metrics for patients in the rest of the U.S. health system, he said.^[10]

Some writers describe socialized health care systems as "single-payer plans." Some writers have described any system of health care which intends to cover the entire population, such as voucher plans, as "single-payer plans,"^[11] although this is an uncommon usage.

Proponents and intent

One of the leading organizations in support of single payer in the U.S. is Physicians for a National Health Program (PNHP), which seeks to establish a system similar to that in Canada. To meet Wikipedias quality standards, this article or section may require cleanup. ...

In Congress, Rep. John Conyers, Jr. (D-MI) has introduced The United States National Health Insurance Act (HR 676). HR 676 has 76 co-sponsors, including Dennis Kucinich (D-OH), who is a candidate for president.^[12] John Conyers, Jr. ... The United States National Health Insurance Act also known as the Expanded and Improved Medicare for All Act and officially called HR 676,[1] is a bill submitted to the United States House of Representatives by Representative John Conyers Jr. ... Dennis John Kucinich (born October 8, 1946) is an American politician of the Democratic party and a candidate for President of the United States in both 2004 and 2008. ...

Converting to a single-payer system is seen by proponents as a solution to the flaws in the current U.S. system. The U.S. health care system is the most expensive in the world on both a per-capita basis and as a percentage of GDP.^[13] Despite this expenditure, the current U.S. system fails to provide universal coverage. Nearly 47 million Americans, about 16 percent of the population, lacked health insurance in 2006.^[14] The lack of universal coverage contributes to another flaw in the current U.S. health care system: on most dimensions of performance, it underperforms relative to other industrialized countries.^[15] In a 2007 comparison by the Commonwealth Fund of health care in the U.S. with that of Germany, Britain, Australia, New Zealand, and Canada, the U.S. ranked last on measures of quality, access, efficiency, equity, and outcomes.^[15] Commonwealth Fund is a charitable fund established in 1918 by Anna Harkness, with Edward Harkness as its first president. ...

For example, U.S. ranks 22nd in infant mortality, between Taiwan and Croatia,^[16] 46th in life expectancy, between Saint Helena and Cyprus,^[17] and 37th in health system performance, between Costa Rica and Slovenia.^[18]

The U.S. system is often compared with that of its northern neighbor, Canada (see Canadian and American health care systems compared). Canada's system is largely publicly funded. In 2004, Americans spent an estimated US$6,102 per capita on health care, while Canadians spent US$3,165.^[19] A 2007 review of all studies comparing health outcomes in Canada and the U.S. found that "health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent."^[20] Government and private health and public policy analysts have compared the health care systems of Canada and the United States. ...

Proponents of health care reform argue that moving to a single-payer system would reallocate the money currently spent on the administrative overhead required to run the hundreds^[21] of insurance companies in the U.S. to provide universal care.^[22] An often-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 30 percent of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs.^[23]

Theoretically, advocates suggest, shifting the U.S. to a single-payer health care system could provide universal coverage, give patients free choice of providers and hospitals, and guarantee comprehensive coverage and equal access for all medically necessary procedures, without increasing overall spending. Shifting to a single-payer system could also theoretically eliminate oversight by managed care reviewers, restoring the traditional doctor-patient relationship.^[5]

Opponents and criticisms

The neutrality of this section is disputed. Please see the discussion on the talk page.

Several criticisms have been leveled against the idea of changing the U.S. health care system to a single-payer system. Image File history File links Unbalanced_scales. ...

Perhaps the largest obstacle is a lack of political will.^[24]

While polling data indicate that U.S. citizens are concerned about health care costs and think the system needs reform (see Polls, below) most are generally satisfied with the quality of their own health care. According to a Joint Canada/United States Survey of Health in 2003, 86.9% of Americans reported being "satisfied" or "very satisfied" with their health care services, compared to 83.2% of Canadians.^[25] In the same study, 93.6% of Americans reported being "satisfed" or "very satisfied" with their physician services, compared to 91.5% of Canadians (according to the study authors, that difference was not statistically significant).

Some medical researchers say that patient satisfaction surveys are a poor way to evaluate medical care. Researchers at the RAND Corporation and the Department of Veterans Affairs asked 236 elderly patients at 2 managed care plans to rate their care, then examined care in medical records, as reported in Annals of Internal Medicine. There was no correlation. "Patient ratings of health care are easy to obtain and report, but do not accurately measure the technical quality of medical care," said John T. Chang, UCLA, lead author.^[26][27][28] Alternate meanings: See RAND (disambiguation) The RAND Corporation is an American think tank first formed to offer research and analysis to the U.S. military. ...

For this reason, some U.S. reformers argue for other, more incremental changes to achieve universal health care, such as tax credits or vouchers.^[29] However, proponents of a single-payer system, such as Marcia Angell, M.D., former editor of the New England Journal of Medicine, assert that incremental changes in a free-market system are "doomed to fail."^[30] The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ...

Other criticisms of single-payer health care as a solution for universal coverage in the U.S. include:

• A single-payer system could put the government, rather than health care providers and insurers, in the role of deciding which procedures and medications would be covered.
• In a single-payer system where hospitals and practitioners remain private, public money goes into private hands and therefore must be guarded to protect public trust. This could require a level of bureacracy similar to the bureacracy associated with private insurance.

Note however, that this issue does not arise in total public health care systems (which may also be single-payer) where the hospitals and / or general practitioners work for the government. In this case the prioritization of access to government funded services is done according to the patients' needs as judged by medical professionals. There are no bureaucrats cross-checking doctors records against either patients medical insurance cover (as in the present system) or against medical contracts (as in a single-payer system with private practitioners).

• Converting to a single-payer system could be a radical change, creating administrative chaos.^[31]

Polls

In recent public opinion polls, majorities of Americans say that the current health care system needs fundamental changes, and that they are dissatisfied with the quality and costs of health care, although they are satisfied with the quality of their own health care. Those polled believe the federal government should guarantee insurance for all Americans, even if they had to pay higher taxes. In some polls, respondents prefer a universal health insurance program, "like Medicare," even if it limited their choice of doctors, and even if there were waiting lists for non-emergency treatments. But respondents were split when they were asked whether the federal government should require all Americans to participate in a national health plan.

According to a New York Times/CBS News poll in February 2007, ^[32] 54% of respondents said that "fundamental changes are needed" in the health care system, and 36% said that "Our health care system has so much wrong with it that we need to completely rebuild it." 57% were dissatisfied with the quality of health care in this country, although 77% were satisfied with the health care they themselves received. 81% were dissatisfied with the cost of health care, and 52% were dissatisfied with the costs of their own health care. 65% said that providing for the uninsured was more important than keeping costs down. 95% said that it is a serious problem that many Americans do not have health insurance. 64% said that the federal government should guarantee health insurance for all Americans, and 60% would pay higher taxes to do so. But only 43% said that it would be fair for the government in Washington to require all Americans to participate in a national health care plan funded by taxpayers, compared to 48% who said it would be unfair. The New York Times is an internationally known daily newspaper published in New York City and distributed in the United States and many other nations worldwide. ... CBS News logo, used from Sept. ...

According to a Washington Post-ABC News poll in October 2003,^[33][34] 62% of respondents preferred "a universal health insurance program, in which everybody is covered under a program like Medicare that's run by the government and financed by taxpayers," compared to 32% who preferred the current system, in which most people get their health insurance from employers. 56% would support a universal health insurance program even if it limited their own choice of doctors, and 63% would support it even if it meant there were waiting lists for some non-emergency treatments. ... ABC News Special Report ident, circa 2006 ABC News is a division of American television and radio network ABC, owned by The Walt Disney Company. ...

State proposals

Several single payer referendums have been proposed at the state level, but so far all have failed to pass: California in 1994,^[35] Massachusetts in 2000, and Oregon in 2002.^[36] Official language(s) English Capital Sacramento Largest city Los Angeles Largest metro area Greater Los Angeles Area  Ranked 3rd  - Total 158,302 sq mi (410,000 km²)  - Width 250 miles (400 km)  - Length 770 miles (1,240 km)  - % water 4. ... This article is about the U.S. state. ... Official language(s) (none)[1] Capital Salem Largest city Portland Area  Ranked 9th  - Total 98,466 sq mi (255,026 km²)  - Width 260 miles (420 km)  - Length 360 miles (580 km)  - % water 2. ...

In 2006, the state legislature of California passed SB 840, The Health Care for All Californians Act, a single payer health care system, but Governor Arnold Schwarzenegger (R) vetoed the bill. California State Senator Sheila Kuehl has reintroduced the bill.^[37][38] Arnold Alois Schwarzenegger (German pronunciation (IPA): ) (born July 30, 1947) is an Austrian-born American bodybuilder, actor, and politician, currently serving as the 38th Governor of the U.S. state of California. ... Sheila Kuehl Sheila James Kuehl (born February 9, 1941 in Tulsa, Oklahoma) is an American politician and former child actress. ...

References

Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 142nd day of the year (143rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 142nd day of the year (143rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 142nd day of the year (143rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 240th day of the year (241st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 72nd day of the year (73rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 240th day of the year (241st in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 142nd day of the year (143rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 72nd day of the year (73rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 72nd day of the year (73rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 72nd day of the year (73rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 142nd day of the year (143rd in leap years) in the Gregorian calendar. ... For information on Wikipedia press releases, see Wikipedia:Press releases. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 239th day of the year (240th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 142nd day of the year (143rd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 141st day of the year (142nd in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... is the 231st day of the year (232nd in leap years) in the Gregorian calendar. ...

See also

• Canadian and American health care systems compared
• Consumer driven health care
• Fee-for-service
• Health care
• Health care reform
• Publicly-funded health care
• Sicko (film)
• Socialized medicine
• Universal health care

Government and private health and public policy analysts have compared the health care systems of Canada and the United States. ... This article or section is in need of attention from an expert on the subject. ... Fee-for-service is health care coverage in which doctors and other health care providers receive a fee for each service such as an office visit, test, procedure, or other health care service[1]. Fee-for-service health insurance plans typically allow patients to obtain care from doctors or hospitals... A physician visiting the sick in a hospital. ... (This article is about political movements affecting the delivery of health care and health care systems. ... Publicly-funded health care is a health care system that is financed entirely or in majority part by citizens tax payments instead of through private payments made to insurance companies or directly to health care providers (health insurance premiums, copayments or deductibles)[citation needed]. // Publicly-funded health care systems are... For other uses, see Sicko (disambiguation). ... Socialized medicine or state medicine or Universal Health Care is a term used in the United States to describe health care systems which operate by means of government regulation and subsidies derived from taxation. ... Universal health care is a situation in which all residents of a geographic or political region have access to most types of health care. ...

External links

• Institute of Medicine Committee on the Consequences of Uninsurance. Hidden costs, value lost: uninsurance in America. Washington, DC: National Academies Press, 2003. [8] Frequently-cited source.
• Physicians for a National Health Program Advocates for single-payer system. Extensive source material from peer-reviewed journals.
• [9] National Center for Policy Analysis Corporate-funded free-market think tank opposed to single payer health insurance
• Boffey, Phillip The Socialists Are Coming! The Socialists Are Coming! Editorial on U.S. "socialized medicine" in the military, the Veterans Health Administration, and Medicare, The New York Times, September 28, 2007
• Single Payer, Universal Health Care For The United States - Myths and Facts