by Henry Mann
The recently implemented Affordable Care Act (ACA), also referred to as Obamacare, has been causing a stir among citizens of all ideological backgrounds since its introduction in October of 2009. The commotion has been one of elation among some and dread among others. There have been shouts of unconstitutionality and socialism, joined with cries of universality and equality.
One well-known critic of the ACA is Michael Moore, the filmmaker, author, social critic and political activist famous for his controversial yet eye-opening documentaries. In an article published in the New York Times entitled The Obamacare We Deserve, Moore criticizes the ACA for stopping short of what the country truly needs—a single-payer healthcare system that is under the direction of the federal government.
Moore’s proposition raises an important question: While the ACA is an attempt to establish universal healthcare, what are the inherent benefits and drawbacks associated with the implementation of a true single-payer healthcare system as opposed to a multi-payer healthcare system?
Just as with the ACA, there are mixed opinions when it comes to single-payer healthcare systems in other countries, such as Canada and Great Britain. Many proponents of the system tout the fact that Canada spends less per capita on its citizens’ healthcare than the U.S., while opponents of the system declare that the National Health Service (NHS) of Great Britain has led to rundown hospitals, underpaid staff and long waiting lists.
To distinguish, a single-payer healthcare system is a financial system for funding healthcare in which one entity acts as the “payer” for all of the health insurance provided to the citizens of the country. In countries such as the United Kingdom, the payer or administrator of the healthcare is the government or a government-run organization. In countries such as Canada, the government contracts with private organizations to offer healthcare to the citizens of the country.
In all forms of single-payer health insurance, the citizens are financing the universal healthcare program through their taxes. Whether the system is funded by a combination of payroll taxes on employers and income taxes on employees, the costs for healthcare would come from the pockets and paychecks of the citizens to be distributed by a central agency.
Many advocates of a single-payer healthcare system cite the financial benefits that may occur as a result of eliminating the plethora of private health insurance companies and creating a single fund through which all funds trickle in and all expenses flow out. Canadian health expenditures average nearly $6,000 per capita every year, while the United States spends an average of just over $8,000 per capita every year. The difference between the systems? Canadian healthcare costs are funded almost entirely by taxes.
According to Gerald Friedman, an economics professor at the University of Massachusetts, an expansion of Medicare would result in a decrease in healthcare costs for 95% of people. Harvard researchers argue that a transition to a single-payer healthcare system in the U.S. would significantly reduce the amount of money lost in administrative waste, which occurs as a result of having so many different “payers” or insurance companies in the system.
The idea of a single-payer system in the United States is not a radically novel idea. After the Second World War, President Harry Truman followed in the footsteps of his predecessor by issuing a plea to Congress that the U.S. transition to a single-payer healthcare system. As history records, the American Medical Association opposed to idea, Congress pursued the issue no further, and the multi-payer healthcare system remained intact.
Small steps were made toward a form of a single-payer system with the introduction and establishment of Medicare and Medicaid in 1965 under President Lyndon B. Johnson. Currently, the costs of both Medicare and Medicaid account for over 17% of the U.S. Gross Domestic Product.
However, the issue often forgotten or not considered is the sustainability of such a system in the United States. In a country where only 54% of its citizens pay federal incomes taxes, due to exceptions made based upon income levels and tax benefits, one has to speculate how the federal government would successfully finance and support such an extensive healthcare system in the long-term.
In addition, a 2010 poll by the Associated Press revealed that 85% of the public is concerned that the currently rising national debt will harm future generations. With such an attitude prevalent among a majority of the country, one is forced to wonder if there is a financial system that could be put into the place that would cover the over 300 million citizens who currently require such care. When highlighting the running success—which is often debated—of the single-payer healthcare systems in countries such as Canada and Great Britain, many seem to neglect the fact they are comparing countries whose populations are nearly ten times less than that of the United States.
Furthermore, the demographics of the U.S. population vary significantly in comparison to those of Canada and Great Britain. For example, the greater per capita spending in the U.S. is largely the result of the rising number of elderly who are in need of care at the end of their life.
Thus, before turning over the organization and distribution of healthcare to the federal government by implementing a single-payer system, consider the words of Thomas Jefferson: “A government big enough to give you everything you want, is a government big enough to take away everything that you have.”