Healthcare
Healthcare is one of the most important provisions of a government to the people and because it constitutes the health of a nation, which determines other social-economic aspects of life in the state. The choice of healthcare is therefore critical and characteristic of the type of government, tax systems, and economic status. The US uses multi-payer healthcare for the majority of the citizens but also employs single-payer for a select group of people. The objective of this study is to explore the possibility of single-payer healthcare in the US to identify the advantages accrued for the general population, as opposed to just a few members of the society.
Defining a Single-Payer Healthcare System
A single-payer healthcare system refers to a type of universal health plan that is paid for by taxes that cover the cost of essential health concerns for all residents in the country, with the financing done under a single public system (Munn and Wozniak, 2017). Medical researchers and commentators have often attempted to redefine a single-payer system to simplify understanding for the general public. Maeda & Niu (2019) contend that a system of healthcare is considered if it fulfills four major factors. First, the government or a government-contracted entity is responsible for most of the operational aspects of the healthcare plan. Decter (2017) collaborates the submissions of Maeda & Niu (2019) when he states that the Canadian government either funds healthcare or outsources to selected medical facilities. Secondly, the eligible population, primarily the working class, contribute to the financing of healthcare. While the third factor is the government’s role to adopt the receipts and expenditure, the fourth factor is the reduction of the role played by private insurers to supplement coverage under the public plan (Maeda & Niu, 2019). Abelson and Sanger-Katz (2019) contend that the near removal of private insurers as the main factor from the US healthcare system has been the subject of contention, causing the rejection of single-payer system but pharmaceutical companies and a section of the wealthy. The non-single payer healthcare system is set such the insurance companies act as secondary employers, which adds the deductibles for the general population and affecting the overall payment. Yu and Zhang (2017), (Decter, 2017) and Abelson and Sanger-Katz (2019) agree that the complexity of non-single care in the United States has made healthcare one of the leading factors of negotiation during a job application.
Proposals for a Single-Payer Healthcare System
The advocacy for adopting a single-payer healthcare system has received support from politicians, medical practitioners, a majority of the population and a section of the wealthy. According to Abelson and Sanger-Katz (2019), 2016 Democratic presidential candidate Bernie Sanders has been one of the most vocal people citing the need to introduce universal healthcare in the country. However, the BBC News (2019) views the advocacy of Senator Sanders as a push for the total abolishment of the US healthcare system, and in particular the elimination of private insurers as the main financiers of people’s health. Former US President Barrack Obama’s attempt to introduce universal healthcare failed despite his landmark Obamacare plan which still left 27 million Americans uncovered (Berchick, Hood and Barnett, 2018). As of 2019, the US uses the Medicare plan that covers person over the age of 65 years and those with special disabilities while providing subscription options for the rest of the population depending on a person’s needs. Senator Sanders advocates for “Medicaid for All” which entails the sponsorship of the American healthcare system from one point, the government (Abelson and Sanger-Katz, 2019). Given that both Senator Sanders and Barrack Obama were Democrats, there is often confusion over Medicaid for All and Obamacare. Abelson and Sanger-Katz (2019) and BBC News (2019) agree that unlike Obamacare which focuses mostly on spreading coverage to the entire population, Bernie Sanders’ means that the government would agree to pay private healthcare providers a given rate for their services to the citizens.
Besides politicians, the advantages of a single-payer healthcare system have prompted public and private physicians and medical researchers to propose the approach to care. Troy (2018) wrote an article to provide a physician’s perspective on why the US citizens need to abolish the current Medicaid plan that is profit-oriented. Primarily, given that a majority of Americans do not have health insurance, they have high deductibles and thus wait for longer for medical services. The waiting period causes the illnesses to grow stronger and deeper leading to injuries, ill-health, disability, poor productivity and eventually low standards of living (Troy, 2018). The support for single-payer healthcare has resulted in many predictions and projections, all of which show the numerous advantages over the current Medicaid program. According to Perez (2017), one of the speakers at the Scottsdale Institute’s Spring 2017 Conference, Paul Keckley, predicted that the US population would seek a referendum in 2020 to introduce a single-payer system. A 2017 study by the Pew Research center indicated that 60 % of Americans felt that the government was responsible for providing care to the entire population the same as Canada, under a single-payer system. Perez (2017) and Troy (2018) agree that while most American feel the need to change the current healthcare system in the US, they disagree on the approach to universal healthcare.
The proposals for a referendum or the hopes of an elected candidate who would introduce a single-payer health system may be objected by the prevailing circumstances around the current system. While Abelson and Sanger-Katz (2019) recognize the complexity of Medicare and also acknowledge the advantages of a single-payer system, they relay the fact that abolishing the current system would be disruptive to the economy and a majority of Americans. Statistics indicate that private health insurers employ 500000 people in the US covering approximately 250 million Americans with revenues of over $1 trillion (Abelson and Sanger-Katz, 2019). Frank (2018) also recognizes that a single-payer system would constrain the income of doctors and other service providers significantly. While these are the primary objections of the general population, Bernie Sanders has often noted that another advantage of a single-payer system is the equitable taxation of the citizens such that the middle class and the poor do not incur the same tax as the wealthy and receive poorer care.
The Tangible Benefits of Single-Payer Healthcare System
Most of the conversations surrounding healthcare in the United States and other pioneering countries are predicated on money and the cost of running the system. Yu & Zhang (2017) undertook a study to examine the differences between a single-payer system such as in Canada and Australia, a two-tier system in France and Japan and the insurance mandated care in the US and Switzerland. After comparing all the plans, results revealed that Canada and Australia spend almost half of what the US and other insurance-led systems spend per year. Primarily, although mixed care such as in Japan and France have superiority, Universal healthcare reduced the overall health expenditure, saving the government and the taxpayer a lot of money that can be used to improve services (Yu & Zhang, 2017). Frank (2018) adds that the reduction of costs of healthcare does not translate into poor service and instead means improved systems as the government can diversify and offer contracts to the best private practitioners. Therefore, it can be argued that by using the single-payer system, the government can improve coverage and livelihoods of the most affected demographics such as military veterans, minorities and people with special needs (Berchick, Hood and Barnett, 2018).
Ayres (2019) analyzed the available research on single healthcare systems and wrote the common advantages and limitations of the approach. Although the increase in tax may seem like an unwanted disadvantage, the coverage of all American and payment of the same rate to all providers creates leverage that enhances competition in the sector. Maeda & Niu (2019) contend that the monopoly of pharmaceuticals and insurance companies in the US has resulted in limited competition, which explains the low standards of care in most facilities, especially the public hospitals. However, Ayres (2019) realized that when the government creates a large pool of sourcing the money to fund universal healthcare, there is spending leverage because more money means a higher bargaining power. If one of the worries is limited income for doctors and service providers as noted by Frank (2018), Ayres (2019) informs that the private insurance option would still be available under a single-payer system, allowing practitioners to cover the margins beyond the government-mandated rates in universal care.
Research on the benefits and limitations of single-payer systems of care is fragmented and various institutions prefer to discuss a given factor. For example, while Yu & Zhang (2017) were inclined to the expenditure costs, Blumberg & Holahan (2019) view access to care and changes in points of service as the most significant advantage of single-payer systems. If Medicaid for All would remove premiums and out-of-pocket payments, then the financial burden on the cost of care does not fall disproportionately on a few people but is spread across the population. Consequently, access to care would increase significantly particularly for people with low incomes and modest incomes. Overall, broad-based implementation would cover a majority of the illnesses alluded by Berchick, Hood, and Barnett (2018) to be uncovered by Medicaid such as dental, vision, long-term support and service (Blumberg & Holahan, 2019). Easy access to care is essential as affording to pay for medicine and treatment.
Abelson and Sanger-Katz (2019) and the Perez (2018) report that one of the reasons for the inclination of most Americans towards a single-payer system is the inconsistency of services offered by the private insurers with some complaining of fraud. Schiff, Bindman & Brennan (2014) contend that a single-tier system of healthcare can enable the government to monitor the services offered to citizens without necessarily infringing on the privacy of private practice. For example, a unified, confidential and computerized medical database can track the behavior of the patients and the service provider, with a view of improving the overall healthcare. Such additions to the healthcare sector can also reduce the financial conflicts that occur between physicians and patients with the latter complaining for lack of proper knowledge on coverage.
The complexities of the American government, usually the bipartisan Senate and Congress, often means that policies of health care may take longer to discuss and approve. When Bernie Sanders and Rep Jim McDommet introduced the Medicaid for All to the 113th Congress and the Senate, there were apparent divisions due to the numerous policy scenarios under the current Medicaid program (Liu, 2016). The introductions of universal healthcare for all would mean that leaders and citizenry from both the Democratic and Republican side would experience the same healthcare, and even the changes to the system would be easier. Abelson and Sanger-Katz (2019) note that Bernie Sanders is still troubled to convince a majority of his colleague in Capitol Hill on the benefits of single-tier healthcare, a fact that continues to the people represented by the Republican representatives and senators. Bauer, Hicks & Casselman (2018) further explored the policy benefits of single-payer healthcare and determined that the option would help the government in other areas such as the identification of undocumented immigrants. For example, as of 2018, there were 3 million people unregistered with Medicaid, 2 million of whom were illegal immigrants. The creation of options in the universal healthcare plan would mean that income-eligible undocumented immigrants would be covered, but can also start the process of acquiring citizenship. Such policy developments would eradicate some of the problems associated with illegal immigration which has been one of the reasons for President Trump’s desire to scrap Obamacare (Frank, 2018). The notion that Democratic-led policies and bill are liberal to the point of allowing undocumented immigrants to be registered to government services may be false but can be eliminated by new health policy. Regardless of the benefits to policy development, access to care and availability of healthcare, Papavlassopulos, Keppler, and Johnson (2016) are adamant that the primary advantage of a single0tier healthcare system is the savings on health expenditure for the citizens, state and federal governments.
Conclusion
The debate on the benefits versus the demerits of universal healthcare and specifically Medicaid for all in the US has been the subject of political and social dialogue. Senator Bernie Sanders, who is also a 2020 presidential aspirant has been the most vocal personality on the need for the US to adopt the route of Canada and Australia and improve the health of the people. Besides saving the cost of healthcare expenditure, other advantages of a single-tier system include easy access to care, affordability for all demographics, equitability and improved services due to leverage and competition among service providers. Research on single-tier care in the US is inconclusive because of the ongoing negotiations of laws and bills to the same effect.
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