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Single payer healthcare: Pluses, minuses, and what it means for you – Harvard Health

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Reading: What does single payer health insurance mean

As someone who researches health care inequities, I’ve diligently followed the health care reform debate. however, most of my friends (and I suspect most Americans) are wondering exactly what single payer health care is and how it will affect them. In a new england journal of medicine perspective article, jonathan oberlander, phd, professor of social medicine at the university of north carolina at chapel hill, lays out the history and obstacles facing calls for health reform in single payer.

problems with the current us. health system

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oberlander points out that the impetus to reorganize the entire health care system has to do with the sorry state of health in the united states. Currently, the financial structure of health care is made up of an impressively complicated web of multi-payers, involving private and government health insurance options. Despite spending more on health care than comparable countries, the US uu. it has the lowest life expectancy and performs poorly on a variety of health outcomes. therefore, our complex network of insurance plans is wasteful, largely due to high administrative costs and lack of price control.

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inequity is another important problem. The United States remains the only developed country without universal health care. The Affordable Care Act has made important strides in improving and expanding health insurance coverage. however, it was never designed to provide universal health care, and 30 million Americans remain uninsured.

what is a single payer health system?

In a single-payer health care system, instead of multiple competing health insurance companies, a single public or quasi-public agency assumes responsibility for funding health care for all residents. that is, everyone has health insurance under a single health insurance plan and has access to necessary services, including doctors, hospitals, long-term care, prescription drugs, dentists, and vision care. however, people can still choose where to receive care. it’s a lot like medicare, hence the us. uu. single-payer moniker “medicare for all.”

Advocates argue that a single payer system would solve several problems in the us. uu. system. Universal health coverage would be a big step toward equality, especially for uninsured and underinsured Americans. overhead and waste could be better controlled through cost control and lower administrative costs, as evidenced in other countries. furthermore, a single payer system has more incentives to direct health spending towards public health measures. for example, allocating funds to childhood obesity prevention programs in elementary schools and day care centers reduces the rates and complications of obesity more effectively and at less cost than paying for doctor visits to recommend healthier diets and increased physical activity.

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At the same time, we must also recognize the potential advantages and disadvantages of transitioning to a single-payer system. long wait times and restricted availability of certain health care services (such as elective surgery or cosmetic procedures) are major criticisms. therefore, despite its advantages, single payer will not alleviate the ongoing tension of balancing access, quality, and cost in health care. However, Oberlander suggests that these problems are much smaller in countries with single-payer health care compared to the US. uu. current. system.

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how could single payer in the us be successful? uh?

oberlander implies that the main obstacles to the adoption of medicare for all are political problems, rather than real practical problems within the single-payer structure. Stakeholders who stand to lose, such as health insurers, organized medicine, and pharmaceutical companies, represent a powerful opposition lobby. public opinion needs to be redirected to focus on how the net benefits of a single-payer system outweigh the trade-offs discussed above. furthermore, despite the savings at the individual level, behavioral economics predicts that the general public will cringe at the idea of ​​shifting health care spending from employers to higher taxes administered by the federal government. Furthermore, despite the projected long-term savings of moving to a single-payer system, the upfront costs of the transition are also politically unpopular.

a path to follow

if the main barrier to implementing single payer health care in the us. uu. it is a matter of politics, the way forward will require mobilizing public support. a recent poll suggests that 58% of americans support medicare for all. Interestingly, while most physicians support the transition to single payer, they are less likely to believe that their colleagues share this view. This raises an interesting question about whether the “conventional wisdom” that it is too difficult to reorganize the health insurance system overshadows actual public opinion.

Multiple strategies have been proposed to continue promoting Medicare for all. This includes individual states implementing a single payer system as a feasibility demonstration, which failed prior to implementation in Vermont, but will be on the 2016 ballot in Colorado. One alternative proposes implementing a single-payer system at the federal level by lowering the Medicare qualifying age every few years. Through educating the general population on the merits of single payer, perhaps the public will eventually vote for politicians willing to overcome the political barriers of medicare for all.

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