Single-payer healthcare: Difference between revisions - Wikipedia

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Taiwan instituted a single-payer system, called the National Health Insurance (NHI), in 1995. In a 2009 interview, Dr. Michael Chen, Vice President and CFO of Taiwan's National Health Insurance Bureau, explained that before NHI was instituted, Taiwan "sent our people around the world to learn their programs, including the United States" to compare models. Dr. Chen indicated that Taiwan's single-payer NHI program "is modeled after Canada's Medicare. And there are so many similarities — other than that our program covers all of the population, and (US) Medicare covers only the elderly."<ref>{{cite web| url=http://www.pnhp.org/news/2009/april/jonathan_cohn_interv.php|title=Jonathan Cohn interviews Taiwan's Dr. Michael Chen: The Case for Single-Payer Health Care (Transcript)}}</ref><ref>{{cite web |title=TRNtv:Jonathan Cohn interviews Taiwan's Dr. Michael Chen (Video)|url=http://player.theplatform.com/ps/player/pds/Knmmuhlp3e?pid=Vq2Q_9LKk_AhPrGSWCgdcBmcX6CwnZQn |accessdate=2009-09-11}} {{Dead link|date=September 2010|bot=H3llBot}}</ref>

~~==Public opinion in the United States==~~

==United States==

[[Image:Single Payer Protester.JPG|thumb|150px|left|Costumed supporter of single-payer at an April 2009 protest in New York City]]

{{See also|Health care reform in the United States|Health care in the United States|Public opinion on health care reform in the United States|Medicare for All}}

A number of proposals have been made for a universal single-payer healthcare system in the United States, none of which has achieved significant political support, with polling showing support for various levels of government involvement depending on wording.<ref name="wpasinglepayer.org">[http://www.wpasinglepayer.org/PollResults.html Single-Payer Poll, Survey, and Initiative Results ]</ref> Proposers include [[Physicians for a National Health Program]],<ref>{{cite web|url=http://www.pnhp.org/|title=Physicians for a National Health Program — Health Care is a Human Right}}</ref> [[American College of Physicians|The American College of Physicians]]<ref>{{cite web|url=https://www.entrepreneur.com/tradejournals/article/179007449.html|title=ACP issues call for mandated universal coverage}}</ref> and the American Medical Student Association.<ref>[http://www.amsa.org/uhc/HFA.cfm]{{dead link|date=January 2011}}</ref>

In Congress, Rep. [[John Conyers]], Jr. (D-MI), and Rep. [[Dennis Kucinich]] (D-OH) have introduced the [[United States National Health Care Act]] (HR 676). The bill has been introduced in every term of Congress under the same name since it was first introduced in 2003 in the 108th Congress with 38 cosponsors.<ref>GovTrack. [http://www.govtrack.us/congress/bill.xpd?bill=h108-676 Expanded and Improved Medicare for All Act].</ref>

===Current programs===

[[Medicare (United States)|Medicare in the United States]] is a single-payer healthcare system, but is restricted to only senior citizens and certain other classes of people.<ref name="Chua"/> Government is increasingly involved in [[Health care in the United States|U.S. health care]] spending, paying about 45% of the $2.2 trillion the nation spent on individuals' medical care in 2004.<ref>{{cite news |first=Julie |last=Appleby |title=Universal care appeals to USA |url=http://www.usatoday.com/money/industries/health/2006-10-15-universal-usat_x.htm |work=USA Today |date=2006-10-16 |accessdate=2007-05-22 }}</ref> However, studies have shown that the publicly administered share of health spending in the U.S. is closer to 60%.<ref>Health Affairs, July 2002. Woolhandler, Steffi</ref>

According to [[Princeton University]] health economist Uwe E. Reinhardt, U.S. Medicare, [[Medicaid]], and [[State Children's Health Insurance Program]] (SCHIP) represent "forms of '[[social insurance]]' coupled with a largely private health-care delivery system" rather than forms of "[[socialized medicine]]." In contrast, he describes the [[Veterans Health Administration|Veterans Administration healthcare system]] as a pure form of socialized medicine because it is "owned, operated and financed by government."<ref>[http://online.wsj.com/article/SB118411829790962883.html "Letters: For Children's Sake, This 'Schip' Needs to Be Relaunched"], Wall Street Journal, July 11, 2007, Uwe E. Reinhardt and others.</ref>

The [[United States Department of Veterans Affairs|Veterans Administration]] is a single-payer system and provides excellent quality, said Reinhardt. In a peer-reviewed paper published in the Annals of Internal Medicine, researchers of the [[RAND Corporation]] reported that the quality of care received by Veterans Administration patients scored significantly higher overall than did comparable metrics for patients currently using U.S. Medicare.<ref>{{cite journal |author=Asch SM, McGlynn EA, Hogan MM, ''et al.'' |title=Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample |journal=Ann. Intern. Med. |volume=141 |issue=12 |pages=938–45 |year=2004 |month=December |pmid=15611491 |url=http://www.annals.org/cgi/reprint/141/12/938}}</ref>

===State proposals===

Several single-payer state referendums and bills from state legislatures have been proposed, but so far all have either failed to pass both legislatures or were vetoed by the governor, except for Vermont, see below. California attempted passage as early as 1994,<ref>{{cite web|url=http://www.kff.org/statepolicy/1075-index.cfm|title=The California Single-Payer Debate, The Defeat of Proposition 186 – Kaiser Family Foundation |publisher=Kff.org |accessdate=November 20, 2011}}</ref> [[Massachusetts]] in 2000, and [[Oregon Ballot Measure 23 (2002)|Oregon]] in 2002 and 2011.<ref>{{cite web|url=http://www.heartland.org/Article.cfm?artId=10803 |title=Free-Market Reformers Are Winners in Election 2002 – by Joe Moser – The Heartland Institute |publisher=Heartland.org |accessdate=November 20, 2011}}</ref> House Bill 3510 The Affordable Health Care for All Oregon Act failed to come to a vote in the House Health Care Committee after allowing public testimony on March 11, 2011.

In 2009 the House of Representatives Education and Labor Committee approved an amendment to the House health care bill, which would allow individual states to adopt a single-payer Medicare-for-all-style health plan. The amendment was proposed by Democratic Congress member Dennis Kucinich of Ohio. The [[Kucinich Amendment]] received support from some conservatives supporting [[states rights]] as it would allow states more freedom to explore various models including, but not limited to, single payer.<ref>{{cite web|url=http://www.democracynow.org/2009/7/21/as_obama_continues_push_for_healthcare|title=As Obama Continues Push for Healthcare Reform, House Committee Approves Kucinich-Sponsored Measure to Keep Single-Payer Option Alive}}</ref>

====Minnesota====

In Minnesota, the Minnesota Health Act, which would establish a state-wide single payer health plan, has been presented to the Senate as SF118 and to the House as HF135, in identical language. This bill was passed by several critical committees in both houses, has been designated as a two-year bill, and awaits a second reading in the House Health Care and Human Services Policy & Oversight Committee.<ref>{{cite web|url=http://muhcc.org/minnesotahealthplan/billstatus|title=Status of the MN Health Act SF118 / HF135}}</ref> Two out of three of the 2010 [[Democratic-Farmer-Labor Party]] candidates for governor have indicated they would sign the bill, if passed; the [[Republican Party of Minnesota|Republican Party]] candidate does not support such a measure (two of the candidates interviewed that indicated they would not have since left the race).<ref>{{cite web|url=http://muhcc.org/sites/default/file/MUHCC%20Survey%20Responses%20-%20short.pdf|title=Gubernatorial Candidate Survey}}{{dead link|date=January 2011}}</ref>

====California====

The [[California State Legislature]] has twice passed a state-level single payer bill, SB 840, "The California Universal Healthcare Act" (authored by [[Sheila Kuehl]]), in 2006 and again in 2008.<ref>{{cite web|url=http://www.eastcountymagazine.org/?q=health_care_for_all|title=Healthcare for All Bill Passes — Governor Threatens Veto}}</ref> Both times, Governor Arnold Schwarzenegger vetoed the bill.<ref>{{cite web|url=http://www.calnurses.org/media-center/press-releases/2008/september/rns-say-governor-harming-economy-and-californians-health-with-sb-840-veto.html|title=RNs Say Governor Harming Economy and Californians' Health with SB 840 Veto}}</ref> State Senator Mark Leno later re-introduced "The California Universal Healthcare Act" in March 2009, newly renumbered as SB 810,<ref>{{cite web|url=http://singlepayernow.net/archive/dec-14-holiday-potluck-with-mark-leno/|title=Healthcare Potluck}}{{dead link|date=January 2011}}</ref> and in January 2010, the California Senate passed SB 810. On the last day of the 2010 legislative session, the Democrats pulled SB 810 from the Assembly floor as Governor Arnold Schwarzenegger said he would veto it a third time, with Senator [[Mark Leno]] announcing he would reintroduce the bill again in January the 2011 legislative session as [[Jerry Brown]] is sworn in as the new Governor of California.<ref>{{cite web|url=http://pnhp.org/blog/2010/09/01/democrats-block-california-single-payer-bill/|title=Democrats Block California Single Payer Bill}}</ref><ref>{{cite web|url=http://www.opednews.com/articles/CALIFORNIA-LIBERALS-VICTOR-by-Ruth-Hull-101104-999.html|title=CALIFORNIA LIBERALS VICTORIOUS; AMERICANS MOURN THE LOSS OF THEIR ADVOCATE IN U.S. SENATE}}</ref> The bill has received support from the [[California Nurses Association]]/National Nurses United.<ref>{{cite web|url=http://www.medicalnewstoday.com/articles/177552.php |title=Major Advance For California Healthcare Reform As Senate Passes Medicare For All Legislation |publisher=Medicalnewstoday.com |accessdate=November 20, 2011}}</ref> On January 31, 2012, the bill SB 810 was killed in the State Senate on a vote of 19 ayes to 15 noes.<ref name="SB 810 Killed on the California Senate Floor">{{cite web|title=SB 810 Killed on the California Senate Floor|url=http://californiaonecare.org/sb-810-killed-on-the-california-senate-floor/}}</ref>

====Illinois====

In April 2008, the Illinois House of Representatives' Health Availability Access Committee passed the single-payer bill HB 311, "The Health Care for All Illinois Act,"<ref>{{cite web|url=http://www.healthcareil.org/|title=Health Care for All Illinois}}</ref> favorably out of committee by an 8–4 vote.<ref>{{cite web|url=http://www.ilga.gov/legislation/BillStatus.asp?DocNum=311&GAID=9&DocTypeID=HB&LegId=27071&SessionID=51|title=Illinois General Assembly Bill Status: HB 311}}</ref>

====Pennsylvania====

In February 2010, the 301-member Pennsylvania Democratic State Committee unanimously endorsed a resolution calling for passage of single payer healthcare, Senate Bill 400 and House Bill 1660, also known as the "Family and Business Healthcare Security Act."<ref>{{cite web|url=http://www.pnhp.org/news/2010/february/pennsylvania-democrats-unanimously-endorse-single-payer-senate-bill-400-and-house |title=Pennsylvania Democrats Unanimously Endorse Single Payer Senate Bill 400 and House Bill 1660 |publisher=Pnhp.org |date=February 8, 2010 |accessdate=November 20, 2011}}</ref>

====Montana====

In September 2011, Governor [[Brian Schweitzer]] did a news interview discussing his desire to obtain a waiver from the federal government similar to the waiver Vermont used, and set up their own universal health care system similar to what was established in the Canadian province of Saskatchewan.<ref>{{cite web|last=Jilani |first=Zaid |url=http://thinkprogress.org/health/2011/09/29/332031/montana-governor-waiver-for-single-payer/ |title=Montana Gov. Brian Schweitzer Will Seek Health Care Law Waiver To Establish Single Payer In His State |publisher=ThinkProgress |date=September 29, 2011 |accessdate=November 20, 2011}}</ref>

====Massachusetts====

In Massachusetts, Question 4, a nonbinding referendum was on the ballot in 14 districts in November 2010, asking voters, "Shall the representative from this district be instructed to support legislation that would establish health care as a [[right to health|human right]] regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?"<ref>{{cite web|url=http://pnhp.org/blog/2010/09/22/insurers-continue-health-care-rip-off/ |title=Insurers continue health care rip-off |publisher=Pnhp.org |date=September 22, 2010 |accessdate=November 20, 2011}}</ref> With 222 of 228 precincts reporting, in all 14 districts, including five in which majorities had voted for Republican Senator [[Scott Brown]], Question 4 passed, with 63.5% of the overall votes being cast in favor of the ballot referendum for establishing a Massachusetts single payer system.<ref>{{cite web|url=http://pnhp.org/blog/2010/11/03/single-payer-ballot-questions-pass-in-all-fourteen-massachusetts-districts/ |title=Single payer ballot questions pass in all fourteen Massachusetts districts! |publisher=Pnhp.org |date=November 3, 2010 |accessdate=November 20, 2011}}</ref><ref>{{cite web|url=http://www.boston.com/news/special/politics/2010/ballot_questions/results/ |title=Boston Globe: Ballot Questions (2010) |work=Boston Globe |accessdate=November 20, 2011}}</ref>

====Vermont====

The legislature of [[Vermont]], including both the Democratic and [[Vermont Progressive Party|Progressive Party]], endorses single payer health care and has hired [[William Hsiao]], the designer of Taiwan's single payer health care system, to design three possible systems of universal health care, one being a single payer model. Governor [[Peter Shumlin]] supports this move.<ref>{{cite web|url=http://www.pnhp.org/news/2010/december/in-vermont-single-payer-health-care-in-a-single-state |title=In Vermont, single-payer health care in a single state | Physicians for a National Health Program |publisher=Pnhp.org |date=December 14, 2010 |accessdate=November 20, 2011}}</ref><ref>[http://www.burlingtonfreepress.com/article/20101227/NEWS03/12270311/Expect-strong-push-in-the-Vermont-Legislature-for-health-reforms-in-2011 Expect strong push in the Vermont Legislature for health reforms in 2011 | The Burlington Free Press | Burlington, Vermont]{{dead link|date=November 2011}}</ref>

The Vermont health bill, H.202, has led to the creation of Green Mountain Care, a private/public single payer exchange system that will give universal coverage to Vermonters and create an electronic system of medical records in an effort to make the system efficient and accessible.<ref>{{cite web|url=http://www.pnhp.org/news/2011/february/pnhp-commentary-on-the-vermont-health-reform-bill |title=PNHP commentary on the Vermont health reform bill | Physicians for a National Health Program |publisher=Pnhp.org |date=February 15, 2011 |accessdate=November 20, 2011}}</ref> In April 2011, it passed the Vermont Senate.<ref>{{cite web|url=http://www.wcax.com/story/14518224/vt-senate-approves-single-payer-plan |title=Vt. Senate approves single-payer plan – WCAX.COM Local Vermont News, Weather and Sports |publisher=Wcax.com |date=April 26, 2011 |accessdate=November 20, 2011}}</ref> In May 2011, the governor signed it into law, making Vermont the first state to have a single payer health care system.<ref>{{cite web|url=http://www.pnhp.org/news/2011/may/vermont-poised-to-become-1st-state-to-enact-single-payer-healthcare |title=Vermont Poised to Become 1st State to Enact Single-Payer Healthcare | Physicians for a National Health Program |publisher=Pnhp.org |date=May 26, 2011 |accessdate=November 20, 2011}}</ref>

===Other proposals===

[[Physicians for a National Health Program]]<ref>{{cite web

| url = http://www.pnhp.org/publications/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance.php| title = Proposal of the Physicians' Working Group for Single-Payer National Health Insurance| publisher = Physicians for a National Health Program}}</ref> the [[American Medical Student Association]]<ref name="Chua">{{citation | last = Chua | first = Kao-Ping | title = Single Payer 101 | publisher = American Medical Student Association | place = Reston, Virginia | year = 2006 | url = http://www.vt4singlepayer.org/images/userfiles/SinglePayer101-1%5B1%5D.pdf | accessdate = 11 April 2012 }}</ref> and the [[California Nurses Association]]<ref>[http://www.calnurses.org/media-center/in-the-news/2007/september/page.jsp?itemID=32125992 Single-payer, or Medicare for all, is the way to go]{{dead link|date=January 2011}} from the California Nurses Association / National Nurses Organizing Committee.</ref> are among those that have called for the introduction of a single payer health care program. In Congress, Rep. [[John Conyers]], Jr. (D-MI) has repeatedly introduced The [[United States National Health Care Act]] (HR 676). As of August 2008, HR 676 had 91 co-sponsors.<ref>{{cite web |url=http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00676:@@@P |title=H.R. 676 |accessdate=2008-08-26 |work=Library of Congress THOMAS }}</ref>

The [[Congressional Budget Office]] and related government agencies scored the cost of a universal health care system several times since 1991, and have uniformly predicted cost savings,<ref>Physicians for a National Health Program (January, 2008) [http://www.pnhp.org/facts/single_payer_system_cost.php?page=all "Single Payer System Cost?"] ''pnhp.org''</ref> probably because of the 40% cost savings associated with universal preventative care.<ref>Hogg, W., ''et al.'' (2005) [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079830/ "Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis"] ''BMC Health Services Research'' '''5''':20</ref>

The issue has often been debated, most recently in the 2008 presidential elections. A CBS News/''[[New York Times]]'' poll published in February 2009 reported that 59% say the government should provide national health insurance (up from 40% thirty years earlier)<ref>{{cite press release| title = CBS NEWS/NEW YORK TIMES POLL| publisher = CBS NEWS| date = Sunday, February 1, 2009| url = http://www.cbsnews.com/htdocs/pdf/SunMo_poll_0209.pdf

| quote = Americans are more likely today to embrace the idea of the government providingealth insurance than they were 30 years ago.}}</ref> A study published in the Annals of Internal Medicine concluded that 59% of physicians "supported legislation to establish national health insurance" while 9% were neutral on the topic, and 32% opposed it.<ref>{{cite journal |author=Carroll AE, Ackerman RT |title=Support for National Health Insurance among U.S. Physicians: 5 years later |journal=Ann. Intern. Med. |volume=148 |issue=7 |pages=566–7 |year=2008 |month=April |pmid=18378959 |url=http://www.annals.org/cgi/reprint/148/7/566}}</ref>

===Public opinion in the United States===

Advocates of single-payer point to wide support<ref>[http://www.washingtonpost.com/blogs/wonkblog/post/wonkbook-voters-like-their-single-payer-health-care/2011/05/25/AGji2BBH_blog.html "Wonkbook: Voters like their single-payer health care"], Washington Post.</ref><ref>[http://voices.washingtonpost.com/ezra-klein/2009/06/health_reform_for_beginners_th_1.html "Health Reform for Beginners: The Difference Between Socialized Medicine, Single-Payer Health Care, and What We'll Be Getting"], Washington Post</ref> especially in polls,<ref name="wpasinglepayer.org">[http://www.wpasinglepayer.org/PollResults.html Single-Payer Poll, Survey, and Initiative Results], Western PA Coaltition for Single-payer healthcare</ref><ref name="2/3">"[http://www.pnhp.org/sites/default/files/docs/2011/Kip-Sullivan-Two-thirds-support-medicare-for-all.pdf Two-thirds of Americans support Medicare-for-all]," PNHP.</ref><ref>[http://www.npr.org/templates/story/story.php?storyId=98374633 Single-Payer Health Care: If Not Now, When?], NPR.</ref><ref name="NPR2">[http://www.npr.org/templates/story/story.php?storyId=106969104 Single Payer: The Health Care Plan Not On The Table], NPR.</ref><ref>[http://www.medicareforall.org/pages/Chart_of_Americans_Support Chart of Americans’ Support], Medicare for All.</ref><ref>"[http://www.healthcare-now.org/another-poll-shows-majority-support-for-single-payer Another Poll Shows Majority Support for Single-Payer]," [[Healthcare-NOW!]]</ref> although the polling is mixed depending on how the question is asked:

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[[Politifact]] rated a statement by [[Michael Moore]] "false" when he stated that "[t]he majority actually want single-payer health care."<ref name="politifact1">{{cite web|url=http://www.politifact.com/truth-o-meter/statements/2009/oct/01/michael-moore/michael-moore-claims-majority-favor-single-payer-h/ |title=Michael Moore claims a majority favor a single-payer health care system |publisher=PolitiFact |accessdate=November 20, 2011}}</ref> According to Politifact, responses on these polls largely depend on the wording. For example, people respond more favorably when they are asked if they want a system "like Medicare."<ref name="politifact1"/>

~~==United States==~~

~~[[Image:Single Payer Protester.JPG|thumb|150px|left|Costumed supporter of single-payer at an April 2009 protest in New York City]]~~

~~{{Health care reform in the United States}}~~

~~{{Main|United States National Health Care Act}}~~

~~{{See also|Health care reform in the United States|Health care in the United States|Public opinion on health care reform in the United States|Medicare for All}}~~

~~===Current programs===~~

~~{{hus}}~~

~~===State proposals===~~

~~====Minnesota====~~

~~====California====~~

~~====Illinois====~~

~~====Pennsylvania====~~

~~====Montana====~~

~~====Massachusetts====~~

~~====Vermont====~~

~~{{main|Vermont health care reform}}~~

~~===Other proposals===~~

~~[[Physicians for a National Health Program]]<ref>{{cite web~~

==See also==