You Decide

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U.S. flag with medical symbol in place of stars and dollar bill as stripes, stethoscope resting atopShould the United States adopt a single-payer, universal health care plan?

  • Yes? But have you considered...
  • No? But have you considered...

…that some assert that the only American model for single-payer health care — Medicare — has failed?

Medicare is a federal program that gives health care coverage to U.S. citizens who are 65 years or older or who have a disability. In 2000, approximately 40 million Americans relied on Medicare; that number is expected to balloon to roughly 80 million by 2035. And although Medicare payments are supplemented for some Americans by state-run Medicaid programs, the Center for Studying Health System Change reports that one in four Medicaid patients say they couldn’t afford to fill a prescription last year.

For opponents of universal health care plans, Medicare repeatedly and vividly illustrates why a government-run system won’t work. Despite the good intentions of the system, both patients and doctors complain of the red tape involved in the Medicare program. Also, research has indicated that Medicare and Medicaid patients face obstacles in getting the care they need, such as required prior approval for certain drugs, limits on prescriptions and co-payments that they can’t afford.

Moreover, many argue that in many cases Medicare assistance does little to diminish the overall cost of health care. Tom Miller, director of Health Policy Studies at the Cato Institute, explains the primary problem with Medicare: “As fiscal pressures mount, the federal government does not ‘negotiate’ with medical providers for lower prices for covered services. It dictates below-market reimbursements with its near-monopoly power as a purchaser of health care for seniors. The full costs of such price discounts eventually reduce access to quality care and hold health care markets hostage to political exploitation.”

For many critics, Medicare has also been deemed a failure because it limits patient care and input. Doctors and patients alike assert that patient care and freedom of choice is a right that should not be subverted by the health care system. “Americans should have the inalienable right to choose how they want to meet their medical needs. This founding principle alone should be enough to cancel the idea of a one-size-fits-all monopoly,” write Michael Glueck, M.D., and Robert Cihak, M.D.

…that other countries successfully use universal health care systems?

The United States is the only developed nation that doesn’t offer its citizens universal health care. Some countries in Europe, including Germany, Austria, Hungary, Norway, Britain, Russia and the Netherlands, started with “compulsory sickness insurance” as early as 1883, largely to protect people against sickness and thereby stabilize their incomes.

For many proponents of universal health care, good examples of other countries‘ successes abound among the 30 or so countries that have universal health care. Here is a list of some of the types of universal health insurance and the countries that have implemented them.

  1. Single-payer national health insurance system: Health insurance is publicly administered, and most physicians are in private practice. (Examples: Canada, Denmark, Norway, Sweden)
  2. National health services: Salaried physicians are the norm, and hospitals are publicly owned and operated. (Examples: Great Britain, Spain)
  3. Highly-regulated, universal, multipayer health insurance system: Universal health insurance via a sickness fund that pays physicians and hospitals uniform rates that are negotiated annually. (Examples: Germany, France)

Many universal health care advocates hail Canada, a nation that adopted a national single-payer system in 1966, as successful example. With a population of 30.5 million people (roughly the same as California), Canada has an infant mortality rate of 4.6 per 1,000 live births and an average life expectancy of 80.3 years — compared with 6.4 and 78.0, respectively, in the United States.

In an op-ed piece, Dr. Sandra Hutchison — Canadian author, lecturer and journalist — recalled her experiences growing up under her country's health care system, explaining that it “… wove itself into the fabric of my life. Its reliability and availability was a given.”

“I don’t remember ever waiting very long to see the doctor, and when I did, he didn't asked me whether it was a ‘sick’ visit or a ‘well’ visit, but simply what it was that I needed from him. And he stayed with me as long as was needed to give it.”

For some proponents of universal health care, the fiscal benefits enjoyed by countries with universal health care are even more compelling than the emotional ones.

“Canada spends $1,000 less per capita on health care than the U.S., but delivers more care and greater choice for patients,” reports Physicians for a National Health Program, an American organization. Additionally, Canadian doctors’ overhead amounts to 34 percent of gross income and “trivial amounts of time on billing” while American doctors spend 44 percent of gross income on overhead and devote 134 hours to annual billing.


Considering this, should the United States adopt a single-payer, universal health care plan?

Nothing about the issues facing the candidates and American voters in 2008 is black and white. With these You Decide activities, you can explore both sides of an issue, put your own critical thinking to work, and discuss the pros and cons with others. In the end, perhaps you will ask different — and better — questions than those presented here.


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