Healthcare reform has been a topic of debate in the United States for decades.
Two terms often used to discuss it are “universal healthcare coverage” and “single-payer” system.
Yet “single-payer” as a definition doesn’t always offer clarity when describing specific policy proposals.
Verywell / Laura Porter
This article delves into what the two terms mean, including their similarities.
It offers some examples of how these healthcare delivery systems are implemented around the world.
But the U.S. does not have the sort of universal coverage provided in many other developed countries.
The government is the only “single payer.”
Single-payer systems can be implemented without covering the entire population.
A country can have one or more single-payer programs and still not achieve universal coverage.
In the U.S.,Medicareand theVeterans Health Administrationare examples of single-payer systems.
Although it’s a form of government-funded health coverage, the funding comes from two sources rather than one.
If you buy a health plan through the exchange, you do not have government-run coverage.
However, countries like Canada and France operate two-tier systems that provide basic care via a single-payer system.
Secondary private coverage is available for those who can afford a higher standard of care.
This is similar toMedigap policiessold to people covered underOriginal Medicarein the U.S.
Many people with Original Medicare rely on private Medicare supplemental coverage (Medigap) to cover out-of-pocket costs.
Others rely on Medicaid or coverage from a current or former employer to supplement their Original Medicare.
What Is Original Medicare?
Most Medicare enrollees get Part A without a premium, but there’s a monthly premium for Part B.
In the VA system, the government owns the facilities and employs the health care providers.
who provide care to Medicare beneficiaries.
They simply bill the government for the services they provide, much like the American Medicare program.
It would mean that healthier, more affluent Americans would still need to purchase their own policies.
It is possible to have a U.S. single-payer system without also having universal health coverage.
This has remained unlikely because the federal government would need to be the single-payer.
Senator Bernie Sanders of Vermont during his presidential campaigns.
Most of them have achieved 100% coverage, with their populations served through the benefits of universal healthcare.
This is lower than the OECD average of almost 98% among its member nations.
Only Costa Rica and Mexico have a lower percentage of their residents covered for core health services.
Various countries have achieved universal or near-universal coverage in different ways.
Germany
Germany has universal coverage but does not operate a single-payer system.
Instead, everyone living in Germany is required to maintain health coverage.
But Singapore also requires everyone to contribute 4% to 10.5% of their income to a MediSave account.
In Singapore, the government directly subsidizes health care rather than insurance costs.
Japan
Japan has universal coverage but does not use a single-payer system.
Technically speaking, the U.K. model can also be classified as socialized medicine.
Funding for the U.K. National Health Service (NHS) comes from tax revenue.
Residents can purchase private health insurance if they choose.
Single-payer health coverage refers to a system in which one entity pays for residents' medical services.
In most cases, the payer will be the country’s government, using funds collected via taxes.
It’s common for the terms single-payer and universal coverage to be conflated.
Estimates vary, depending on the model proposal and underlying political position.
Plans also would impact gross domestic product (GDP) and the economy overall.
The Navigator role was specifically created the ACA legislation.
Liu JL, Brook RH.What is Single-Payer Health Care?
A Review of Definitions and Proposals in the U.S.J Gen Intern Med.
2017 Jul;32(7):822-831. doi:10.1007/s11606-017-4063-5
Keisler-Starkey, Katherine.
U.S. Census Bureau.Health Insurance Coverage in the United States: 2022.
World Population Review.Countries With Single Payer.
Ochieng, Nancy, et al.
KFF.A Snapshot of Sources of Coverage Among Medicare Beneficiaries.
Dec 13, 2023.
The Commonwealth Fund.International Health Care System Profiles: England.
The Commonwealth Fund.International Health Care System Profiles: Canada.
1976 - Medicare for all act of 2021.
OECD Indicators.Health at a Glance 2023.
Organisation for Economic Co-operation and Development.Health at a Glance.
All About Berlin.Public and private health insurance in Germany: how to choose?
2016;9:2132. doi:10.2147/RMHP.S93285
United Kingdom, National Health Service.An Introduction to the NHS.
Congressional Budget Office.Economic Effects of Five Illustrative Single-Payer Health Care Systems.
healthinsurance.org.How are states making efforts to provide health coverage to undocumented immigrants?
Cornell Law School, Legal Information Institute.42 U.S. Code 18031 - Affordable choices of health benefit plans.
