Single Payer Health Insurance

“Single payer”—the system used in Canada and other countries—gets its name from its most essential feature: One payer, a public agency, replaces the 1,500 insurance companies. It becomes the sole reimburser of clinics and hospitals. That one agency has the authority to set limits on what doctors, hospitals, and drug companies can charge. Patients go to doctors and hospitals of their choosing. The traditional Medicare program is an example of a single-payer system.


Leaving the bloated insurance industry in place perpetuates the pain and cost of the current health care system. Photo: Jim West/jimwestphoto.com.The U.S. spends twice as much per person on health care as other industrialized nations. Single payer is the only system that can achieve universal coverage for the same or less money than the nation spends now.

Replacing all those insurance companies and dozens of government programs with one payer slashes the huge costs incurred by doctors, clinics, and hospitals on billing and arguing with insurance companies about how to treat patients. It wipes out what insurers spend on marketing and excessive salaries, and what they take in profits.

The issue that unions are sidestepping is whether the mere presence of a public program in the jungle of private insurance companies would force private insurers to lower premiums without resorting to delaying or denying care to some.

What is more likely to happen is that the insurance industry would “compete” with the public program by rationing the care received by their sicker enrollees, pushing some to sign up with the public program instead.

For another view of the health care dilemma in this issue of Labor Notes:

Sandy Eaton: In Health Care Reform, Massachusetts Shows How Not To Do It
This would in turn drive the public program’s premiums up and the private premiums down. Eventually the public program would be driven out of the market.


Some liberals say they support single payer but won’t work for it because the insurance industry is too powerful to beat. But Stern bases his trash talk on a more baseless and insidious claim—that average Americans oppose single payer.

He says we embrace a hyper-patriotism that causes us to resist adopting good ideas from other countries—even Canada—and are so satisfied with our current insurance companies that we will fight any attempt to replace them.

Stern’s perception is contradicted by many polls and focus groups. A December 2007 AP poll, for example, found that 65 percent of Americans support “a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.” A poll by ABC News in 2003 found 62 percent in favor.

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