Healthcare provision in the U.S. is complicated with a long turbulent history of successes and failures of a robust system that has failed to live to its expectations. Despite spending almost double as much per capita for healthcare as compared to other developed countries, the US health metrics are among the lowest when compared to other peer nations. The Trump administration has hinted at repealing the Affordable Care Act (ACA) but it is unclear what system would replace it and whether it will be better or worse. Therefore, policymakers and interest groups have been mooting the idea of adopting a single-payer system to ensure that all Americans are insured regardless of income or status in society. Proponents of this new system call it “Medicare for All”, and it has been termed as the easiest route to universal health coverage in the US. However, like any other proposal, the single-payer system has been criticized with opponents citing numerous challenges that it would present to care providers and other stakeholders. This policy position paper discusses the single-payer system by highlighting its evolution, major policymakers involved, nursing role in it, and the associated ethical challenges.
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Single-Payer System – An Overview
A single-payer is system is a form of universal healthcare whereby services are financed through taxes to cover all costs associated with healthcare for all citizens (Liu & Brook, 2017). The costs are paid by one entity, such as the government, hence the term “single-payer”. This system will ensure that everyone accesses healthcare services regardless of class, race, income status, or any other demographic. Currently, despite the introduction of the ACA in the American healthcare system, many people are either uninsured or underinsured. Healthcare in the US is extremely expensive and when people have to pay from their pockets, chances of becoming bankrupt are high. Ironically, despite being the largest spender in healthcare, the country scores poorly on major health indicators. For instance, the US has “12.2 maternal mortality deaths per 100,000 compared to 4.8 in Canada which, like other developed nations, has a single-payer health care program” (Martin, 2017, p. 182). Therefore, there is a need to look for better alternatives to ensure that Americans receive quality care services commensurate with the huge amounts of money spent on the same for better health outcomes and quality of life.
The history of a single-payer system in the US is long and it dates back to the times of President Franklin Roosevelt in the 1930s when he proposed the adoption of a universal healthcare plan as he devised the Social Security scheme (PNHP, 2019a). President Truman also attempted to introduce such a program but in 1953, Congress defeated his efforts. President Lyndon Johnson also had a similar proposal but the opposition could not allow its implementation. President Barack Obama openly supported a single-payer system, but his efforts did not bear fruits and the closest he came was the adoption of Obamacare policies (PNHP, 2019a). When the ACA was passed in 2010, it was assumed that it would address some of the major problems facing care provision to Americans. However, as mentioned earlier, millions of people are still uninsured or underinsured, which means they cannot access quality and timely healthcare services. This issue has captured the attention of policymakers and when the Trump administration took office, there have been attempts to repeal the ACA and replace it. Therefore, the inadequacies of the ACA have presented an opportunity for policymakers to rethink and re-strategize on how to improve health care provision to the citizens.
Currently, the major policymakers interested in the introduction of a single-payer system are mainly Democrats. All the 2020 presidential aspirants from the Democratic wing agree that a single-payer system should be adopted in the US, but they disagree on how to implement the process. Sen. Elizabeth Warren and Sen. Bernie Sanders propose a government-run insurance system for all Americans, thus significantly reducing the involvement of the private sector (Feinstein, 2019). Other candidates like Joe Biden and Beto O’Rourke would rather maintain the current system and develop it further for better service delivery. Currently, Sen. Sanders’s Medicare for All bill, with 14 co-sponsors has been introduced to Congress. Other interested groups in the single-payer system include the American Nursing Association (ANA), Physicians for a National Health Program (PNHP), American Association of Community Psychiatrists (AACP), American Public Health Association (APHA), and the US Public Interest Research Group among other similar affiliations (PNPH, 2019b). All these organizations and groups are advocating for the adoption of a single-payer system in the US healthcare system to ensure that everyone is covered.
The role of nursing in policymaking has become relevant in a changing world where care delivery should be evidence-based. Nurses, through their umbrella professional organization, ANA, are championing for policy change to legislate a single-payer system in the US. ANA has joined other like-minded organizations to lobby Congress to adopt Sen. Sanders’ Medicare for All Bill. At local levels, nurse leaders are championing grassroots support by creating awareness through different channels that are available for such a task. Patient education is one of the ways that nurses can sensitize the masses about the importance of having a single-payer system. If the proposed system is adopted, nurses will benefit significantly. First, the role of nurses is to provide care to all people, and thus a single-payer will ensure that people access care services hence that objective will be met. Second, a single-payer system will mean that health care facilities will have the resources needed to hire enough nurses and other support staff. Therefore, the problem of nurse shortage will be addressed and nurses can offer care services optimally without the suffering associated with staff shortage.
The major ethical concern related to the single-payer system is the increased taxation of citizens to cover the costs associated with this program. Currently, the U.S. healthcare system is worth $3.5 trillion (Feinstein, 2019). Therefore, for the government to get this money, means it has to expand its tax base and impose more tax on different classes of people. Currently, Americans are overtaxed, with federal taxes taking up to 24 percent of national income (Bird, 2019). Therefore, imposing more taxes on people seems unethical. In addition, such a scheme will mean that the youth, who mostly do not incur huge medical expenses, will have to pay for the aged population through taxation. It would be unethical to force healthy young people to pay for services they may not use shortly.
This ethical dilemma could be solved in two ways. First, it could be ignored, which means the entire US citizenry will be heavily taxed regardless of whether someone will require care services or not. Second, federal waivers and administrative cost-cutting at the hospital level could be introduced (Levitt, 2018). However, this option may lead to rationing and quality compromise.
I prefer the first option of increasing taxation because the second alternative is not viable. Introducing cost-saving measures would adversely affect the quality of care, which is counterproductive because while people will have access to care, they will get poor services, which affects their quality of life. Additionally, the issue of young people paying for services they might not need could be addressed by arguing that they will be paying forward. Ultimately, they will age and require those services, and thus youth should not be used as an excuse to stifle such a revolutionary policy change to improve the quality of life across generations.
The ACA was supposed to address the many challenges that the US healthcare system faces, but it has failed with millions of people being uninsured or underinsured. Such people cannot access quality care services, which means their quality of life is poor. This realization has awakened policymakers, especially democrats, to champion a different and better system. Sen. Sanders has introduced a bill in Congress with the support of other 16 senators. A single-payer system means that the government will assume all the responsibilities of ensuring that Americans are insured and they can access quality and timely care services. However, this system means that Americans will be highly taxed for the government to have enough money to fund healthcare for all. While there are some ethical issues associated with taxing the youth for services they may not need shortly, I would rather they pay it forward for the creation of a robust health care system for all.
Bird, B. (2019). How much does the average American pay in taxes? Web.
Feinstein, A. (2019). Here’s how ‘Medicare for All’ would affect every part of the $3.5 trillion US healthcare system. Business Insider. Web.
Levitt, L. (2018). Single-payer health care: Opportunities and vulnerabilities. JAMA, 319(16), 1646-1647.
Liu, J. L., & Brook, R. H. (2017). What is single-payer health care? A review of definitions and proposals in the U.S. Journal of General Internal Medicine, 32(7), 822-831. Web.
Martin G. M. (2017). Views on the ethical struggle for universal, high quality, affordable health care and its relevance for gerontology. Experimental Gerontology, 87(1), 182-189. Web.
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PNHP. (2019a). A brief history: Universal healthcare efforts in the US. Web.
PNPH. (2019b). Organizations and government bodies endorsing HR 676 / single-payer. Web.