Understanding Single-Payer Health Care: “Medicare for All”

A recent commentary (J Oberlander. NEJM 2016; 374: 1401-3) explains the “virtues and vices of single-payer health care.”

“In a country where nearly 30 million persons remain uninsured, even insured patients face staggering bills, and more money is spent on administration than on heart disease and cancer, it’s no surprise to hear calls for sweeping change.”

Virtues of Single-Payer System:

  • Based on Canadian experience, single-payer greatly reduces administrative costs and complexity.
  • Concentration of purchasing power
  • Guarantee that all residents receive care
  • The problems of a single-payer system “pale in comparison” to the current U.S. system

Vices of Single-Payer System:

  • Wait lists for some services
  • Public dissatisfaction
  • Would require increased taxes (though may improve overall finances for most)

It Does Not Matter if Single-Payer is Better:

It would face intense opposition from insurers, medical industry, and would not be adopted by Congress. “In short, single payer has no realistic path to enactment in the foreseeable future.”

My take (in agreement with author): “Preserving and strengthening the ACA [affordable care act] as well as Medicare, and addressing underinsurance and affordability of private coverage is a less utopian cause than single payer. I believe it’s also the best way forward now for U.S. medical care.”

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