Acton Institute Powerblog

Explainer: What you should know about single-payer healthcare

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Today, Vermont Senator Bernie Sanders is unveiling his legislation for a single-payer healthcare system. Here is what you should know about single-payer systems and Sanders’s proposal:

What is single-payer healthcare?

In a single-payer healthcare system, the government pays for all medically necessary service for of all citizens, regardless of income or ability to pay.

Does the U.S. have a single-payer system?

In the U.S. most citizens over the age of 65 and people under 65 who have specific disabilities qualify for the single-payer system know as Medicare. The expansion of this single-payer system to all citizens is sometimes referred to as “Medicare for all.”

The state of Vermont also attempted to create a single-payer system but scrapped the idea in 2014. As Sarah Kliff explains, “budget analysts realized Vermont would need an additional $2.5 billion in tax revenue to pay for the system. That would have required raising the payroll tax by 11.5 percent and income tax by 9 percent.”

Isn’t the Affordable Care Act (Obamacare) a single-payer system?

No. Obamacare is an expansion of government requirements to cover previously uninsured people. Obamacare does not collect money that is paid directly to medical providers but instead relies on currently existing private insurance companies.

What is Sander’s single-payer proposal?

Sen. Sanders has introduced the “Expanded & Improved Medicare For All Act.” The purpose of the legislation is “To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.”

Currently, Sanders has 15 Senate Democrats as co-sponsors for the bill.

What benefits would be covered under Sanders’s single-payer plan?

Everyone living in the U.S. would receive by mail a Medicare For All Program Card after filling out a 2-page registration form. All medically necessary services would be covered, including at least the following:

(1) Primary care and prevention.

(2) Approved dietary and nutritional therapies.

(3) Inpatient care.

(4) Outpatient care.

(5) Emergency care.

(6) Prescription drugs.

(7) Durable medical equipment.

(8) Long-term care.

(9) Palliative care.

(10) Mental health services.

(11) The full scope of dental services, services, including periodontics, oral surgery, and endodontics, but not including cosmetic dentistry.

(12) Substance abuse treatment services.

(13) Chiropractic services, not including electrical stimulation.

(14) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).

(15) Hearing services, including coverage of hearing aids.

(16) Podiatric care.

How would the law determine what medical practices qualified and what prices would be paid?

According the bill, the benefits would be available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.

Additionally, no deductibles, copayments, coinsurance, or other cost-sharing would be imposed with respect to covered benefits.

No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers would be allowed to continue to operate as private entities, but would be prohibited from being investor owned.

It would be illegal for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act. Health insurance coverage would still be legal for additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary.

Reimbursement fees and salaries would be determined by the government after “close consultation with the National Board of Universal Quality and Access and regional and State directors.” Initially, the current prevailing fees or reimbursement would be the basis for the fee negotiation for all professional services covered under this Act.

The prices to be paid each year under this Act for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment would be negotiated annually by the Program.

How would this program be paid for?

Mostly by increased taxes, though the amounts have not been outlined. The proposed taxes include:

• Increasing personal income taxes on the top 5 percent income earners.

• Instituting a “modest and progressive” excise tax on payroll and self-employment income.

• Instituting a “modest tax” on unearned income.

• Instituting a “small tax” on stock and bond transactions.

How much would Sanders’s Medicare For All plan cost?

The Congressional Budget Office (CBO) hasn’t yet scored the bill, but it is estimated to cost nearly $1.4 trillion a year.

To put that into perspective, that’s more money than the combined annual budgets for the Dept. of Agriculture ($133 billion), Dept. of Commerce ($9.28 Billion), Dept. of Defense – military programs ($516 billion), Dept. of Education ($60.2 billion), Dept. of Energy ($26.7 billion), Dept. of Homeland Security ($42 billion), HUD (35.8 billion), Dept. of the Interior ($13.2 billion), Dept. of Justice ($31 billion), Dept. of Labor ($44.8 billion), Dept. of State ($25.4 billion), EPA ($7.65 billion), NASA ($16.9 billion), and all international assistance programs ($23.3 billion).

Also, the total revenue taken in federal taxes is $3.21 trillion a year. To add another $1 trillion—a 31 percent increase—would require raising taxes on nearly every American.

Is there a chance this single-payer bill could become law?

No, at least not while the Republicans control the House, Senate, and the White House. And even if the Democrats were to regain control of Congress in 2018 its unlikely they’d have the votes within their own party to pass the bill.

Joe Carter Joe Carter is a Senior Editor at the Acton Institute. Joe also serves as an editor at the The Gospel Coalition, a communications specialist for the Ethics and Religious Liberty Commission of the Southern Baptist Convention, and as an adjunct professor of journalism at Patrick Henry College. He is the editor of the NIV Lifehacks Bible and co-author of How to Argue like Jesus: Learning Persuasion from History's Greatest Communicator (Crossway).


  • disqus_eEbPU3IGDU

    The idea behind single payer health care is that government pays all medical bills. This appeals to people who do not pay much in taxes and who therefore think that single payer health care will allow them to get their health care paid for by somebody else.

  • Steve Vinzinski

    The idea has merit at the same time who is going to pay for the plan.I think who ever is in control would not have ambition to pass this.I like medicare as a self employed person an attorney I provided pension and medical insurance to my employees.That could not be accomplished today. My wife and me are retired so to speak and medicare costs us $4000.00 a year.The secondary with United Health Care thru AARP cost about $20,00.00 a year.That includes health,prescription and dental eye glass is separate.Prescriptions are not covered the way they were and out of pocket costs another $20.000.00.The trump tax plan is to take away this deduction fro the income taxes.The rich have no problem under this new tax bill and the President admits the same form your LLP or LLLC or sub-s corporation.I really believe the single payer would cause another downgrade by SP. Eventually this country will be similar to Russia a couple of decades ago be forced to pass some laws and go bankrupt.This system sounds great but there is to much corruption in the health system.

  • cestusdei

    How does it work in the UK? Waiting times, rationed care, substandard care, shortage of medical personnel, and practical euthanasia by refusing to cover certain procedures and letting the patient die. Of course the rich can go elsewhere, just like now. And those in government, like Congress, get special care at special facilities that are far superior to what the proles get. All of that and much higher taxes. Is that what we want?