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Single-Payer, Nationalized Health Care & Insurance

No one disagrees that health care reforms in the United States aren't needed to bring costs under control, while still providing maximum coverage for people. Legislators and presidents have spoken for decades of providing such lasting health care reforms, but these calls to action generally became grid-locked in Congress and failed.

However, with the 2008-2009 recession, ongoing concerns over the economy, and the passing of the Patient Protection and Affordable Care Act (Obamacare), the debate over nationalized health care now rages quite fiercely.

The current debate is framed in two ways. The first is through the paradigm of rights: Do you have a right to health care? The second is through the efficiency paradigm: How to provide affordable, effective health care?

Is health care a right?

Proponents of nationalizing health care (single-payer) argue that health care is a right. They often point to the United Nations' Universal Declaration of Human Rights for support as well as argue that if "life" is a right (Declaration of Independence) then health care must be provided by government to ensure that right to life. 

Those who prefer private health care with free-market reforms, however, believe that health care is not a right. In their estimation rights exist with or without the support of others. Generally, these rights are encompassed in the term "natural rights" and include the right to life (ownership of oneself) and property (the fruit of one's labors), both of which can exist with requiring monetary or other support from other individuals. They further argue that if one individual may demand a right such as health care, then someone else must be forced by government to pay for it. They see this act as individuals enslaving other individuals through government force to pay for their "rights." 

How to provide affordable, effective health care?

From the efficiency perspective, proponents of a single-payer system believe that it would be more cost effective than the current system. Evidence of the inefficiencies of the current system are found in the numbers of uninsured, rising health care costs, and a wobbly economy. Additionally, proponents will point to single-payer systems' performances in other nation-states. Essentially, the belief is that a health care system funded and controlled by a central government (creating a monopoly on health care) is better.

Those in favor of a private system of health care argue that a government monopoly on health care is not the most efficient system. Instead, they point to the successes of the private sector in providing for consumers when competition and freedom are embraced. While "socializing" health care may grant larger coverage, they argue it will dilute the quality of health care provided, promote rationing, and ultimately prove fiscally unsustainable at a time when the national debt is soaring.

Additionally, free marketers and others argue that the reason for rapidly rising health care costs is a result of the third-party payer system put in place by government tax codes and regulations. In this system, few consumers of health care (patients) are directly responsible for paying the bill, and therefore there is little incentive to drive costs down. Universal health care can only drive costs down by regulating prices or rationing since the consumer (patient) isn't responsible for the costs of care. Solutions to the third-party payer problem can be achieved (without nationalizing health care or taking on more debt) by reforming the tax code, changing interstate insurance rules, and modifying other issues stemming from government regulations.

Whatever reform looks like, it will affect your future significantly, now is the time to learn what the experts and pundits are saying about nationalizing health care.

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If Congress unveils legislation to reform the health care system that reflects the policies outlined by President Obama, then this would "centralize control over the health care system in Washington." Owcharenko writes that "the chief danger of this approach is that it would directly interfere in the personal health care decisions of Americans." Instead, the author argues, "there is a much...

This co-authored article by the Governor of South Carolina and a professor at the Standford University Medical Center argues that "in practice, government-run health systems by and large fail the very patients they were created to protect. In these systems, access to doctors, surgeries and new lifesaving treatments are severely limited. Innovation is discouraged, and medical technologies are...

Lueck writes: "To make a choice of affordable, comprehensive health plans available to individuals and small businesses under health reform, it is crucial to set benefit standards to ensure that all plans in a health insurance exchange cover a comprehensive array of services." This critical commentary discusses what universal benefits are necessary as basic coverage in a nationalized health...

Michael Reagan, son of former President Ronald Reagan, argues in this short commentary piece that the hidden danger in universal health care reforms is the premium placed on efficiency. An ideal system of universal care requires uniform benefits-according to Reagan, however, the current legislation will allot a disproportionate, unneeded level of benefits to the young as compared to the...

While Congress may look to Massachusetts' health care reforms as a model for potential national reforms, Tanner cautions that they think twice. He writes that "experience suggests the 'Massachusetts model' actually provides an object lesson in how not to reform health care. The program has failed in its main goal of achieving universal coverage. It has failed to restrain the growth in health-...

"Health care initiatives often get derided as a patchwork, an inefficient and uncoordinated effort to fix something that really needs a more comprehensive approach.

By comprehensive, most think single-payer European-style health systems.  But would a single-payer...

In this newspaper editorial, Cato Institute's Micahael Tanner writes that "the actuarial firm Lewin Associates estimates that, depending on how premiums, benefits, reimbursement rates and subsidies were structured, as many as 118.5 million people, roughly two-thirds of those with insurance today, would shift from private to public coverage - or be pushed. Businesses would have every incentive...

Book, a Ph.D. Senior Fellow at the Heritage Institute  explains the foolishness behind the idea that increasing health care costs might stimulate the economy. He writes that "at the crux of the argument are the notions that increasing spending on health care will create jobs that can be filled by those losing jobs in other areas of the economy--and that implementing long-proposed reforms...

"Ezekiel Emanuel reminded New York Times readers last week of something health economists have known for eight decades. Health expenditures are highly concentrated, with just 10 percent of the population accounting for nearly two-thirds of annual health spending. Wall Street protesters have sparked a fierce debate over trends in the share of income and wealth controlled by the top 1 percent....

"With a projected $1.8 trillion deficit for 2009, several trillions more in deficits projected over the next decade, and with both Medicare and Social Security entitlement spending about to ratchet up several notches over the next 15 years as Baby Boomers become...

"If Republicans and moderate Democrats in Congress aren't careful, the only health care reform issue they'll influence this summer will be whether or not the government sets up a Medicare-style public plan to compete with private plans.

The Obama...

Chart or Graph

"What Health Reform Does Not Do. During the debate leading up to health reform legislation, participants discussed many problems and many goals. Here are some goals that will not be achieved:

Health care costs may rise, rather than fall. Although the CBO initially predicted a slight lowering of overall health care costs in future years, it is now...

This chart demonstrates the difference between reasonable and actual wait from the time of appointment with a specialist to the treatment. In 2003, the actual wait reached its height at 9.5 weeks. Since then, the wait has fallen to 8 weeks while the reasonable wait is now measured at 5.8 weeks.

This chart graphs the waiting time between referrals and appointments in the Canadian provinces. In every province, the waiting period has dramatically increased since 1993. The highest wait is 14.5 weeks in Prince Edward Island.

"How have other countries tried to control health care spending? In general, they have substituted inexpensive services for expensive ones. Citizens of Britain and Canada, for example, see physicians more often than we do. But as the graph...shows, doctors in other countries spend less time with patients on each visit. Also, patients in Britain and Canada have less...

"This report presents long-term trends in the number and percentage of persons under age 65 years with different types of health insurance coverage and with no coverage."

“As the table…shows, [under the Patient Protection and Affordable Care Act] you will get very different subsidies from the government depending on your income and where you acquire health insurance. In general, the new system is much more generous to lower-income families if they obtain insurance in the exchange and is much more generous to higher-income families...

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"Medicare patients have higher average patient care costs, so expressing administrative costs as a percentage of total costs gives a misleading picture of the relative efficiency. Administrative costs per patient are only slightly higher for Medicare than for private insurance. However, patient care costs are much higher for Medicare, so administrative costs are a lower percentage of Medicare'...

"There is an interesting problem with health insurance in the United States. Rather than have consumers evaluate the costs and benefits of different types of coverage, government actively hides the full cost of coverage from consumers. As a result, consumers demand more generous coverage, and much of the care covered by that health 'insurance' is care that they otherwise would purchase...

Analysis Report White Paper

This White Paper calls upon Congress to craft "meaningful health reform legislation that achieves coverage for every American while also addressing the underlying problems in our health system." However, Senator Baucus carefully explains that "it is not intended to be a legislative proposal. Nor is it an exhaustive exploration of every health care issue that should...

"Crossing Our Lines is a bipartisan agreement for comprehensive health reform reached by Senators Howard Baker, Tom Daschle, and Bob Dole. It is the culmination of an inclusive year-and-a-half effort that included strategic outreach to key health care stakeholders, a series of state-based public policy forums, and months of personal deliberations by the Leaders. Taken together, the...

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This article outlines how and why moving beyond employer-based coverage is a good idea for health care reforms. "Individual health care tax credits, in combination with a robust market for insurance products, would offer individuals the opportunity to secure private health care coverage of their own, moving the system closer to a consumer-oriented model that is fairer and more transparent and...

Edmund Haislmaier, a senior health policy analyst at The Heritage Foundation, writes that "it is becoming increasingly clear that the congressional creation of a public health plan to 'compete' with private health insurance plans is a roadblock to serious, bipartisan reform of the American health care system. Such a plan would likely result in the massive erosion of private health insurance...

"This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if America's health care system is not significantly overhauled. Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted. There would be a dramatic decline in...

The ideological arguments around a public plan of health insurance often ignore what the authors of this paper "believe is the central reason for including a public plan as a component of reform: that health insurance markets today, by and large, are simply not competitive. And as such, these markets are not providing the benefits one would expect from competition, including efficient...

This analysis piece examines the spiking numbers of uninsured Americans and forecasts how the 2006 census data may affect different types of health care coverage. A special focus is placed on children's health care: their increasing likelihood of lacking adequate health care has been (and will continue to be) the result of budget shortfalls for many of their programs.

The CBPP is...

Although the Obama Administration has yet to produce a specific reform plan, this White Paper analysis by Cato Fellow Michael Tanner reviews possible reform components which may soon come from Congress. One of these possibilities includes a plan where "every American would be required to buy an insurance policy that meets certain government requirement. Even individuals who are currently...

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From the summary: "In today's health care discussions, the Mayo Clinic is regularly held out as a high value health care provider that delivers high quality at a low cost. There is indeed a strong body of research from Dartmouth Medical School that shows Medicare patients at the Mayo Clinic consistently cost far less and experience superior outcomes when compared to similar patients at clinics...

This paper provides answers concerning the effects of the Patient Protection and Affordable Care Act on the average American citizen. According to the report, health reform will affect the following areas:

    ...

Video/Podcast/Media

 

...

 

...

"Stuart Browning highlights the plight of an Ontario man with a cancerous brain tumor who crossed the border to the U.S. to get the medical care that is rationed in his home country."

 

...

The beginning of this PBS video segment will give one an idea of some of the arguments used by proponents of single-payer health care. The interview by Bill Moyers examines the heated debate surrounding the single payer solution to health care reform. Moyers interviews nurse Deann Mcewen about her previous testimony in front of Congress and her thoughts on the issues as a health care...

Bill Moyers' Journal
PBS
May 22, 2009

The beginning of this PBS video segment will give one an idea of some of the arguments used by proponents of single-payer health care. The interview by Bill Moyers examines the heated debate surrounding the...

Natalie Mehra of the Ontario Health Coalition argues from a pro-socialized health care position. She argues specifically against Brian Day, orhthopaedic surgeon and former head of the Canadian Medical Association, and his promotion of privatizing the Canadian system. Mehra particularly targets his drive for profits and how taking profits often breaks the law. She does...

"Dr. Brian Day, Orhthopaedic Surgeon and former head of the Canadian Medical Association, speaks out on Canadian healthcare." He believes that the money should follow the patient.

 

...
Owcharenko argues that health care reform is needed, but that individuals and families should decide what is best for them and not centralized bureaucrats. Additionally, she points out that the plan will cost over $1 trillion and add $1 trillion to the national debt. Do we really want more debt?
...

 

...

"President Obama's prime-time health insurance speech underscored an important point: No American should have to choose between health insurance and paying rent, between health insurance and getting groceries--or getting drunk, getting designer jeans, or protein powder.

We hear so much about hardworking Americans who need health insurance, but what about the rest of us? Millions of...

...

President Obama argues that a public option will not hurt competition. He compares private health care to FedEx and UPS, while equating the public option to the United States Postal Service. He states, "It's the post office that's always having problems."

"Filmmaker Stuart Browning demonstrates how single-payer health care systems have a lot in common with the failed economic systems of Soviet-era eastern Europe."

...

"The Oregon Health Insurance Experiment is the first study ever to measure the effects of health insurance by randomly assigning subjects to receive Medicaid coverage or no coverage. At this forum, lead investigator Katherine Baicker will present the Oregon Health Insurance Experiment's first set of results and discuss further data that this revolutionary experiment will produce. The panelists...

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Primary Document

"Lee Kurisko is a Canadian radiologist who formerly practiced in Thunder Bay, Ontario, as director of diagnostic imaging for Thunder Bay Regional Hospital. For most of his life, as he has written, he was a 'staunch believer in the moral superiority of...

In my message to the Congress on November 19, 1945, I said that every American should have the right to adequate medical care and to adequate protection from the economic threat of sickness.

"The testimony begins by mentioning a large number of positive aspects of the legislation. The role and importance of an individual mandate is then briefly discussed. It argues that the public plan that is proposed in the plan is important for overall cost containment and for budget savings. The plan would address problems in the current market that are caused by increasing concentration in...

In his speech, Dr. Rohack addresses how to reform healthcare and the AMA's role in it.

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This testimony before the Senate Finance Committee Roundtable on Health Care Reform addresses reforming the process by which health care is delivered. McClellan explains that "Dramatic variations in health care spending that bear little relation to health outcomes highlight the fact that simply trying to subsidize more affordable coverage in our existing health care system is not sustainable...

The official speech transcript from the White House Briefing Room for President Obama's presentation at the Conference of the American Medical Association.

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From the executive summary:

"The Fraser Institute's nineteenth annual waiting list survey found that Canada-wide waiting times for surgical and other therapeutic treatments decreased in 2009. Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.3 weeks in 2008 to 16.1 weeks in 2009. This...

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