Published April 14th, 2020 by USA Rx
Private health insurance currently rules our healthcare system. While the majority of people in the United States receive health insurance benefits through their employers, the government-assisted Medicare covers many Americans or Medicaid plans if they are eligible. Yet, millions of Americans still do not have health insurance plans. This means high out-of-pocket costs on healthcare for these individuals, and given the increasing costs of healthcare in America, implementing changes that can help lessen the financial burden of healthcare for these individuals is important. A Single-Payer Healthcare system has been successfully implemented in many countries across the world. In this system, the government sets and regulates all health claims and provides individuals with their own health plan. In other words, the government is the ‘single payer’ that provides healthcare benefits to members who reside in that country. This is not to be confused with Universal Healthcare, which means health coverage for all. Universal Health care can be provided by multiple companies and can be a ‘multipayer’ system with everyone covered under some plan. The Single-Payer Healthcare system can also be universal, but it is solely run by the government.
How good is it to have a Single-Payer system? It is not easy to exactly weigh the pros and cons of a Single-Payer Healthcare System because they can be set up differently. The countries that currently have Single-Payer systems in place have not structured their plans in exactly the same way. However, since many of the features of this system are common, we can get an overall idea of what the benefits and disadvantages of having such a system could be. The U.S. has a sort of ‘single-payer’ system in place with Medicare, which is not available to everyone, but only to a certain section of the population like senior citizens, younger people with certain disabilities and people with permanent kidney failure. In theory this could be extended to the general population for one Single-Payer system considered as ‘Medicare for All.”
There has been much debate about how this kind of system would affect individual members of the population, private health insurance companies, drug manufacturers, pharmaceutical companies, and the government itself. Here is a list of the major pros and cons that can come with having a Single-Payer Healthcare system.
One of the biggest advantages of Single-Payer Health is that it can make medical care more affordable to all, despite income variability. Everyone gets access to the same kind of healthcare whether it is visits to the doctor’s office, emergency care, preventative care, or hospital stays. In effect, this can lessen societal division when all individuals have access to the same healthcare rights, irrespective of how they make their living. Overall, medical care should become more affordable.
Currently, private health insurance companies have a network of providers that you can avail healthcare benefits from if they are included in your coverage plan. If you use non-emergency services by providers outside of your network, you will most likely not be reimbursed for these costs. Therefore, you are limited to the doctors and services that are offered within your covered network. With a Single-Payer healthcare system, network limitations would mostly be abolished since all healthcare providers and hospitals would fall under one system.
Reduced administrative costs
Hospitals and healthcare providers currently have many administrative staff that performs insurance-specific functions like filing and reviewing claims. Since many different types of health plans under private insurance companies currently exist, this requires a large amount of administrative force. With one Single-Payer Healthcare system, administrative costs would be substantially reduced. Under this system, these administrative costs could be cut, which would result in a more efficient system that helps patients save on health care as well.
Under the current system, patients must search for healthcare providers that accept their insurance plans. The reason for this is to make sure that they will be covered for services they receive, like treatment procedures at an office visit or hospital stays. Some specialists within hospitals also operate under a different insurance than the rest of the hospital, which can come as a surprise to patients who expect the entire hospital to accept one insurance plan. In these cases, the patient can be hit with a high medical bill if their insurance is not accepted. Additionally, if someone needs urgent medical care and does not have time to look up doctors or hospitals that accept their insurance, they can be charged unexpectedly high medical costs. This can be eliminated with a Single-Payer system because all healthcare facilities and physicians will fall under one insurance system.
In a Single-Payer system, the federal government will decide how much prescription drugs will cost. In other countries where this system is implemented, the cost of prescription drugs is much lower than what they cost in the U.S. Single-Payer systems bring the costs of drugs down by assessing the value of the drug themselves, or by using a reference to set the drug price. This reference can either be other drugs in the same therapeutic group as the drug in question, or an external reference of how much the drug costs in other countries. This results in savings for the patient who purchases the drug.
Although a Single-Payer system sounds like it could be ideal, the government must receive the funds to provide healthcare insurance from somewhere. This usually comes from increased taxes on taxpayers to specially fund this system. Countries that have these systems in place do have higher tax rates in general. It is estimated that a Single-Payer Healthcare system can cost the government four times as much as a non-Single-Payer Healthcare system.
Since everyone would have access to the same services, wait time for special medical procedures like surgeries could be long due to a long waiting list of people. In countries like the United Kingdom where a Single-Payer healthcare system is operational, patients have reported waiting more than six months for a scheduled surgery to take place. This problem can lead to patient dissatisfaction and can also be a problem for patients with urgent medical needs. This is not necessarily true for all Single-Payer systems though, and would depend on how the system is structured.
The government would need to set up its own administrative system just to manage a Single-Payer health policy. Current administrative systems exist to manage Medicare, but this would need to be much larger to manage a healthcare system for the entire nation.
Single-Payer systems allow medical providers the option of offering private-pay services only. This means that some medical providers may not accept Single-Payer healthcare coverage and patients under this coverage could be turned away. If more medical providers opt to use private-pay only, the amount and types of services available to the majority of the population could decrease.
The reduced price of prescription drugs under Single-Payer Health can cost pharmaceutical companies much of their annual revenue. An estimated 25% of revenue could be lost, resulting in lower funds available for them to invest in the creation of new drugs. This may lead to an unmet medical need for some disease areas where there is a lack of existing treatment options.
Under the current healthcare system, one of the major factors that contribute to medical debt in the U.S. is the cost of prescription drugs. Since Single-Payer healthcare in the U.S is just a possibility but does not exist yet, what can you do about bringing these costs down with the current system?
Pharmacy discount cards are cards that can be applied to your purchase of all FDA-approved prescription drugs to give you a discounted price off the market list price. Discount cards can give you savings of up to 80% on some prescription drugs. The companies or organization that offer these cards have negotiated with pharmacies and organizations called Pharmacy Benefit Managers to get these lower prices. You can sign up for a discount card with USA Rx. Everyone is eligible to get a discount card. Getting the card is free and can be done online. Simply print the card and present it to your pharmacist when filling your next prescription. The card is accepted at over 90% of pharmacies across the country. You can check the discounted price of your drug at USA Rx before purchasing your drug to find out how much the drug will cost after the card is applied.
So, although we continue to have a relatively high cost of healthcare in our country, there are solutions that can be applied to make the situation better. In the meantime, weighing how a Single-Payer system could change our healthcare structure is worth thinking about.