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Single Payer Facts

Access and Benefits
All Americans would receive comprehensive medical benefits under single payer. Coverage would include all medically necessary services, including rehabilitative, long-term, and home care; mental health care, prescription drugs, and medical supplies; and preventive and public health measures. Care would be based on need, not on ability to pay.

Payment
Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses--a "global budget." A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc.

Doctors would have three options for payment: fee-for-service, salaried positions in hospitals, and salaried positions within group practices or HMOs. Fees would be negotiated between a representative of the fee-for-service practitioners (such as the state medical society) and a state payment board. In most cases, government would serve as administrator, not employer.

Financing
The program would be federally financed and administered by a single public insurer at the state or regional level. Premiums, copayments, and deductibles would be eliminated. Employers would pay a 7.0 percent payroll tax and employees would pay 2.0 percent, essentially converting premium payments to a health care payroll tax. 90 to 95 percent of people would pay less overall for health care. Financing includes a $2 per pack cigarette tax.

Administrative Savings
The General Accounting Office projects an administrative savings of 10 percent through the elimination of private insurance bills and administrative waste, or $100 billion in 1994. This savings would pay for providing medical care to those currently underserved.

Cost Containment
The Congressional Budget Office projects that single payer would reduce overall health costs by $225 billion by 2004 despite the expansion of comprehensive care to all Americans. No other plan projects this kind of savings.

Single Payer from Different Perspectives

Patients
Each person, regardless of ability to pay would receive high-quality, comprehensive medical care, and the free choice of doctors and hospitals. Individuals would receive no bills, and copayment and deductibles would be eliminated. Most people would pay less overall for health care than they pay now.

Doctors
Doctors' incomes would change little, though the disparity in income between specialties would shrink. The need for a "wallet biopsy" before treatment would be eliminated; time currently wasted on administrative duties could be channeled into providing care; and clinical decisions would no longer be dictated by insurance company policy.

Medical endorsements include PNHP (8,000), the American Public Health Association (30,000), American Association of Community Psychiatrists, Massachusetts Academy of Family Practice, American Medical Women's Association (13,500), Alameda-Contra Costa Medical Society, American Medical Student's Association, D.C. Medical Society, National Medical Association (6,500), American College of Physicians (Illinois Chapter), Long Island Dermatological Society, Islamic Medical Association, American College of Surgeons, American Nurses Association, the Nurses' Network for a National Health Program, and the D.C. and Maryland chapters of the American Medical Association.

Hospitals
The massive numbers of administrative personnel needed to handle itemized billing to 1,500 private insurance companies would no longer be needed. A negotiated "global budget" would cover operating expenses. Budgets for capital would be allocated separately based on health care priorities. Hospitals would no longer close because of unpaid bills.

Insurance Industry
The need for private insurance would be eliminated. One single payer bill currently in the House (H.R. 1200) would provide one percent of funding for retraining displaced insurance workers during its first few years of implementation.

Business
In general, businesses would see single payer limit their health costs and remove the burden of administering health insurance for their employees.

Congress
Single payer would be the simplest and most efficient health care plan that Congress could implement.

How a Single Payer Health Plan Works

• A "single payer" would replace the existing 1500 different insurance plans.  The administrative savings derived from eliminating the bureaucratic duplication, marketing costs and profits associated with these plans are immense--$100 billion in 1991, according to the U.S. General Accounting Office.  These savings would be enough to provide coverage for all those persons currently uninsured.
• Further savings would come from replacing itemized billing in hospitals with annual global budgets.  Eliminating patient specific cost accounting (documenting and billing for each item and/or procedure) would free resources for increased clinical care.  The U.S. Congressional Budget Office estimates that these combined savings would reduce overall health costs by $225 billion by 2004 in addition to extending comprehensive care to all.  No other health care plan projects such savings.
• The plan would be federally financed on an ongoing basis through personal and payroll taxes, thereby replacing insurance premium payments with a health care tax.  Proposed taxes on alcohol and cigarettes would also contribute to these funds. 90-95% of Americans would pay less for health care than they do now.
• A balanced national health care budget would be negotiated yearly, with a single insurer in each state, locally controlled but subject to stringent national standards.  Health care providers would negotiate a fee schedule with their state health plan yearly.  Patients would receive no bills.  Providers would be reimbursed directly by the insurer.
• Coverage would be the same for all, regardless of income.  Risks and benefits would be shared by all.

Cartoon courtesy of Konopacki