Health policy: Should the United States Adopt a Universal, Single-Payer Health Plan?

Due February 17, 2005

Yes: Steve Miano

A universal healthcare plan is needed in order to provide medical coverage for all Americans, generate more cost effective healthcare, create better control over prescription drug prices, and give physicians more choice in procedures.  Although obtaining these items of healthcare seem rational, many anti universal healthcare advocates believe the key items mentioned above cannot and should not be obtained.  Therefore, one should try to understand what can be achieved through universal healthcare.


Under a single payer plan of universal healthcare or National Healthcare Insurance (NHI), would include every citizen despite their illness or conditions.  This access to healthcare by every citizen will help improve individual’s health, because they are now able to seek medical attention despite their economic status. NHI will help reduce the rationing of patients.  The NHI will cover every aspect of healthcare for patients “…include acute, long-term, and home care; mental health services; dental services; occupational health care; prescription drug and medical supplies; and preventative and public health measures” (A National, par. 7).  The broadness of care provide by an NHI helps increase American health in general and unlike certain HMOs will never deny, a patient care provided the illness or procedure does not qualify under the HMOs policy. This range of coverage would also help decreases the number of individuals falling bankrupt to illness every year.  For example, it is found that, “rising health care cost, skimpier policies and the cancellation of coverage when illness causes job loss have augmented the financial risk for those with insurance” (Bankruptcy, par. 2). All in all, a NHI would cover these short falls of job loss and individuals would not incur increasing co-payments or policies that do not cover specific illness or treatments.  


            Implementing a single payer NHI also creates a more cost efficient form of healthcare.  NHI allows for disbanding of administrative functions such as billing, budgeting and insurance liaisons.  It is calculated that ending these needless administrative paper trails, “…will save us over $250 billion dollars per year” (How…, par. 3).  Studies also show that, “…administrative savings under NHI from eliminating private insurance companies could fund comprehensive care for all Americans without any increase in overall health cost”  (Bankruptcy, par. 4).  Therefore, with no administrative billing necessary to collect funds from insurance companies or patients how will hospitals and clinics receive their funding?  Funding in an NHI is received through “global budgeting,” or the payment to “each hospital a monthly lump sum to cover all operating expenses…” (Bernardin 260).  This budgeting approach will give hospitals and medical clinics the best and immediate funding to provide prompt healthcare in a timely manner to every citizens. 


            A NHI will also tackle a current problem within todays healthcare programs, the accessibility and affordability of prescription drugs.  “The NHI would negotiate drug and equipment prices with manufacturers, based on their cost” (Bernardin 263).  The NHI will supply these medication and supplies when medically needed.  The patients would have no payment to incur, instead the, “Suppler would bill the NHI directly for any item…prescribed by a licensed practitioner” (Bernardin 263).  This direct business with pharmaceutical companies decrease drug prices and allow all citizens to receive the medications they need. 


            Finally, a NHI will allow doctors to return to the roots of healthcare and no longer require them to be bound by insurance providers as corporate pawns.  The absence of corporate medicine will allow doctors to conduct needed test and give their patients the care needed, not the care that their insurance will provide.  For example, current insurance policies may not cover therapies for those patients with acute illnesses, such as cancer or AIDS patients, but under the NHI chemotherapy and certain medicines would be administered despite their social or economical clout.  All in all, giving doctors the freedom to practice medicine in a respective and healing aspect instead of a corporate business aspect will improve the healthcare of every citizen in America. 




“A National Health Program for the Untied States: A Physicians’ Proposal.”  Physicians

for a National Health Program. 17 Febuary 2005.



“Bankruptcy Study Highlights Need For National Health Insurance.” Physicians for a

National Health Program.  17 Febuary 2005.


“How can we afford a National Healthcare Program?” Campaign for a National

Healthcare Program Now!  17 Febuary 2005.


Bernardin, Cardinal Joseph. “Yes, Proposal for Health Care Reform.” Controversies In

American Public Policy.  Ed. Hird John, Michael Reese, and Matthew Shilvock.           

California: Wadsworth, 2004. 256-272.


No: Bridget Ricks

Should the U.S. Adopt a Single Payer Health Plan?

Bridget Ricks


If the United States were to convert to a Single Payer Health Plan, our medical community will be forever changed.  The quality of health care would decline.  Our doctors would have limited decision making.  The technology available to the citizens of the United States would not be as available or accessible.  Could the Government afford to convert to a Single Payer Health Plan.


The quality of American Health Care would decline.  Dye points out in Chapter Six the number of people waiting for operations in Canada, and the number that die waiting on operations.  Matthews and Cihak in the Hird text point out that 250 cancer infected Canadians came to the United States in 1999 to receive medical treatment because of the length of time they would have to wait to receive treatment in Canada.  Cancer is a very serious illness and with out a quick diagnose and prompt treatment the survival rate of a cancer patient drops drastically.  Medications would be limited and new technology would not be available.  NCHC states the "Good quality means providing patients with appropriate services in a technically competent manner, with good communication, shared decision making, and cultural sensitivity."


New Technology is steadily coming to grasp in the medical field.  Doctors spend years doing research and designing to trying to establish a "break through" in medicine.  How much would the government allow for research and the gathering of advanced knowledge if the United States went to a single payer health care program.  "In a single-payer system where health care budgets are tight, bureaucrats and politicians tend to see new technology as too costly for the benefit" (Hird 286). Most countries that operate on the single payer program, are unable to afford the latest technology, most are unable to afford new technology at all.  So many of our fellow citizens are still with us today because of a break though in technology.


Physicians will be limited to the decisions they will be able to make and who they will be able to treat.  Currently if you go to your physician and they diagnosis you with a disease then they will refer you to a specialist and under the extreme circumstance you will begin seeing the specialist immediately.  However, if the single-payer program was in motion, then the doctors would be regulated on what they could treat, who they could treat, and limited to the process in which they treat patients.  Physicians are lost every year in the Canadian Heath Care. They come to the states to make their living and farther their education.  Very few Canadian doctors remain after fifteen years of service.


Would the American Government be able to afford a Single-Payer Program that would be able to provide services to all of the citizens of this country?  If the United States Government was able to afford a single payer system, there would be too many people needing services than the physicians would be able to attend to.  Hird text discusses the rationing of health care to the elderly, very ill, and very young.  Those in the middle would be the last to receive care.  "Some studies indicate that indigent patients do not get as much are as paying patients", meaning that if you pay,  you will receive better care than if the government is paying the bill.  Hird also states that "a  "free" health care system that relies on very high taxes to fund it is not necessarily affordable-or any better."  Would we be willing to exchange insurance cost for higher taxes, specified care and from whom, limited technology, and poor quality for our medical care.

Hird, Reese, Shilvock, Controversies In American Public Policy, 3rd Edition,  Wadsworth 2004

Dye, Thomas R., Understanding Public Policy, 11th Ed., Pearson Education, Inc., 2005


Rebuttal responses

Steve Miano

Miss Bridget, I understand your feelings of fright when thinking of changing a current system of tradition and selectivity.  Nevertheless, I must disagree with several of the reasons you feel that National Health Insurance is a “bad idea.” 

            First, I believe the quality of healthcare in America will not decrease, it will be strengthened.  Dye even points this out in chapter 5 of his text when he asks the question of whether we would like good health or good medical care, and because good health is hereditary we should focus on good medical care.  Therefore, good medical care according to Dye is “frequent visits to the doctor…and equal access to medical care by rich and poor alike.” (Dye 114)  Therefore, I believe a universal healthcare plan provides these services to everyone and meets the requirements of good medical care, which in reality is all that Americans can do.  You also discussed the rationing of healthcare and how medical attention would be centered on those that are elderly, very ill and very young.  When this is not true and all citizens have the equal chance to access medical attention. For example, those that are old may not be able to afford prescription drugs, those that are ill may not be able to have treatments because they are not covered under their insurance and those that are young may be shuffled out of the hospital because insurance companies do not want to pay but for a set maximum amount of days. 

            As far as physicians go, they are not leaving areas that have universal healthcare because they are not allowed to perform the art of medicine.  They on the other hand, are leaving places like Canada, in search of America because they want more money for their services and they know that HMOs will provide these funds ultimately leading to elevated salaries.  In terms of physicians leaving countries with universal healthcare because they cannot practice freely, this is a misconception.  Because “Physicians would have a free choice of practice settings. Treatment would no longer be constrained by the patient’s insurance status, nor by bureaucratic dictum,” within the NHI plan (Bernardin, 256).  That’s right, it is the insurance companies and bureaucracies that limit care not healthcare reform like NHI that wishes to end HMO’s and the extensive bureaucracy associated with the current healthcare system.

            In terms of payment for such a healthcare reform, that is simple. We would raise taxes universally in order to cover NHI meaning individuals that currently pay taxes but do not have insurance will be awarded healthcare.  Your statement about covering the cost of those whose taxes may not be affected dramatically, is true, but in reality we already cover these individuals with the growing amount of our insurance deductible.  Therefore, at least by raising taxes these individuals will help carry some of the financial burden instead of those with current insurance, paying for the whole part of healthcare. 

            All in all, if we can look beyond our traditionalist views and our middleclass ideologies of “we made it, why can’t they,” mentalities, one may begin to see the light at the end of the tunnel.  And this light is universal healthcare that provides quality medical care to all individuals, ultimately improving the quality of life in America and the world.  


 Works Cited


Dye, Thomas R.  Understanding Public Policy.  New Jersey:Pearson, 2005.


Bernardin, Cardinal Joseph. “Yes, Proposal for Health Care Reform.” Controversies In

American Public Policy.  Ed. Hird John, Michael Reese, and Matthew Shilvock.             

California: Wadsworth, 2004. 256-272.



Bridget Ricks

The cost of going to the single payer health system would hurt the American economy. One of America's leading Insurance providers is BCBS they employee over 150,000 employees nation wide.  That's not so many employees but if you look, they only serve 30% of insured persons in America, then you will see that there is about half a million employees working for Health Insurance Industry.  Can America stand to loose a half a million jobs.  The economy is suffering from lack of employment already.  Also, upon reading on how to fund the single-payer health program, the Bush tax cuts would have to be eliminated.  This would also hurt the economy.  Funding would require 3.3  % tax on all employers and employees would still have to pay the 1.45% Medicare payroll tax.  Also according to Himmelstien their would have to be a small tax placed on stock and bond transfers.  In another paper supporting the single payer health plan Americans making $140,000 to $250,000 would have to pay an additional 5% health tax and Americans with the average income of 1,100,000 would pay 10%.  (Mone)  Is it fair to have those who have ample assist pay for those who do not?  We should not expect because someone pulls in a large income for that person to pay for part of our government programs.  They already contribute with regular payroll taxes. 


While to think that the Single-Payer Health Plan has benefits it would be a great cost.  It would hurt our personal finances, have grave effects on the economy and the unemployment rate, and the government would have to extend their means to establish a new branch of government. 


Walls, Gary:, 8/1996 "Paying for Health Care"


Physicians for a National Health Program web site: 2/1/04


Mone, Lou, Study on Universal Health Coverage in California. 9-2-03