Single-payer healthcare systems refer to health insurance programs that are governed by one organization. These single-payer systems, which can be found worldwide, may vary by how they are funded, who is eligible, what benefits they offer, and more.
Medicare for All is a proposal that would create a single-payer healthcare system in the United States.
In this article, we’ll discuss how single-payer systems work and how Medicare for All stacks up as a proposed health insurance option in the United States.
If passed, Medicare for All will be a tax-funded, single-payer health insurance program that would provide healthcare coverage to every person in America.
The Medicare for All proposal would be an expansion of Medicare, the health insurance program that covers Americans age 65 and older. Medicare is currently broken into different parts: Part A, Part B, Part C, and Part D.
There is also Medicare supplement insurance, also known as Medigap. Each part of Medicare provides different forms of healthcare coverage.
Together, Medicare Part A and Part B are what’s known as original Medicare. Part A covers inpatient care, while Part B covers outpatient services.
Medicare Part C, or Medicare Advantage, covers everything under Medicare parts A and B, as well as extras, such as:
Some Medicare Advantage plans even cover fitness and meal delivery services.
Medicare Part D and Medigap are both add-ons for original Medicare. Medicare Part D is prescription drug coverage, which helps cover the cost of your medications. Medigap is supplemental Medicare insurance that helps cover some of the costs associated with your Medicare plan, like copays and deductibles.
Expanding Medicare to Medicare for All would involve:
- providing coverage for all individuals, regardless of age or health status
- offering original Medicare coverage, including inpatient and outpatient medical insurance
- adding additional coverage, such as reproductive, maternity, and pediatric care
- lowering prescription drug prices and offering more choices for prescription drugs
Medicare for All would also change the way healthcare services are paid for. With Medicare, you are responsible for paying deductibles, premiums, coinsurance, and copays. You must pay these fees to stay enrolled in your Medicare plan and receive coverage.
Under Medicare for All, there would be no monthly premiums or yearly deductibles. You would owe nothing at the time of your services. Instead, your healthcare plan would be prepaid through taxes and contributions.
Medicare for All is only one type of single-payer system. There are a variety of single-payer healthcare systems that are currently in place in countries all around the world, such as Canada, Australia, Sweden, and others.
The overall idea behind a single-payer healthcare system is that one group is responsible for collecting and distributing funds to provide healthcare services to the entire population. However, there is no one single definition of a single-payer system, and there are different ways that a healthcare system like this can be organized.
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- revenue and contributions
- eligible population
- provider payment
- covered benefits
- eligible providers
Further, there were differing options about how each of these functions would be handled under a single-payer system. For example, collection of funds, or revenue, could come from federal funds, taxes, or premiums. Pooling of funds, or eligible population, could be based on an individual’s residency. Allocation of funds, or provider payment, could be population-based, fee-for-service, or global budget.
Generally, when it comes to covered benefits, all single-payer healthcare systems aim to provide coverage for essential health benefits. These benefits include:
- inpatient and outpatient medical services
- preventive and wellness services
- mental health services
- prenatal, maternity, newborn, and pediatric services
- rehabilitation and substance abuse services
Switching to a single-payer healthcare system would likely affect the current government-funded healthcare options, such as Medicare and Medicaid. Some proposals, like Medicare for All, call for an expansion of these programs. Other proposals call for the programs we have to be discontinued in favor of a replacement option in which everyone can enroll.
Here’s how Medicare for All would function as a single-payer healthcare system:
- Revenue and contributions. Medicare for All would be funded through income tax increases, premiums, and contributions.
- Eligible population. All residents of the United States, regardless of age or health status, would be eligible for health coverage under Medicare for All.
- Provider payment. Services administered by Medicare for All providers would be paid for on a fee-for-service basis using a fee schedule.
- Covered benefits. Medicare for All would cover comprehensive health benefits, including any services medically necessary to diagnose, treat, or manage a condition.
- Eligible providers. All providers under Medicare for All must follow national minimum standards and the rules and regulations set by the Act.
As you can see, the Medicare for All program follows the “true” single-payer system model, in which public health insurance is run by the government and funded by taxes. It would be provided to all Americans, without cost-sharing or up-front fees, and without the competition of private insurance plans.
While there are multiple single-payer proposals on the table for healthcare in America, Medicare for All is the most widely known and supported. As a single-payer program, Medicare for All would provide comprehensive healthcare benefits to all Americans at no up-front cost. It would be primarily tax-funded, use a fee schedule for provider payments, and cover all essential health benefits.