Single-payer healthcare facts for kids

Single-payer healthcare is a type of universal healthcare where one group, usually the government, pays for everyone's essential medical care. This payment is typically funded by taxes. The "single-payer" is the government, which acts like a big insurance company for all its citizens.

This system doesn't always mean the government owns the hospitals or employs the doctors. In some countries like Canada, the government pays for care that is delivered by private doctors and hospitals. In other places, like the United Kingdom, the government both pays for and provides the healthcare services.

What is Single-Payer Healthcare?

In a single-payer system, the government collects money, usually through taxes, and uses it to pay for the healthcare needs of all its residents. This approach has several goals. One major goal is to provide universal healthcare, meaning everyone has access to medical care. Another is to lower the overall cost of healthcare for the country and improve people's health.

The World Health Organization and the United Nations General Assembly have both encouraged countries to work towards universal healthcare.

A single-payer system creates one large group of insured people—the entire population. This allows the government to set clear rules for what services are covered, how much doctors are paid, and the prices of medicines.

Many wealthy nations have single-payer systems. Examples include the National Health Service (NHS) in the U.K., Medicare in Canada, and the national health systems in Spain, Taiwan, and Italy.

Where did the term come from?

The term "single-payer" became popular in the 1990s. It was used to describe the difference between Canada's system and the U.K.'s system. In Canada, the government pays private businesses for healthcare. In the U.K., the government both pays for and runs the healthcare services.

Usually, "single-payer" refers to the insurance part of healthcare, not the doctors or hospitals themselves. The government manages the money, which is different from systems where many private insurance companies are involved (a "multi-payer" system).

Countries with Single-Payer Systems

Many countries around the world have single-payer health insurance. These programs provide some form of universal healthcare, but they do it in different ways. Some governments own the hospitals and employ the doctors, like in the U.K. and Spain. Others, like Canada, buy healthcare services from private organizations.

Canada

Canada's healthcare is paid for by the government and is mostly free for people to use. The system is guided by the Canada Health Act of 1984. The government sets standards for quality, but it doesn't get involved in a person's private health information.

The system is known for being simple. Doctors bill the government of their province directly, so patients don't have to deal with insurance claims. The money for this comes from income taxes. Every resident gets a health card and receives the same level of care.

Most basic medical needs are covered, including having a baby. Dental and eye care are often not covered by the government plan but may be covered by insurance from an employer. People can also buy extra private insurance for things like a private hospital room.

Cosmetic surgery is usually not covered. A person's health coverage doesn't change if they lose or switch jobs. There are also no limits on coverage for pre-existing health problems.

Taiwan

Taiwan's healthcare system is run by its Department of Health. In 1995, Taiwan started its National Health Insurance (NHI) program. It is a single-payer system that requires everyone to join. By 2004, it covered 99% of the population.

The NHI is funded by taxes on salaries, along with some payments directly from patients and the government. At first, the system paid for each service separately. This led some providers to offer unnecessary services to get more money from the government.

To control costs, the government switched to a "global budget" system in 2002. This means there is a set amount of money for healthcare each year. Taiwan's system is seen as a success because it is well-managed and provides care to nearly everyone.

South Korea

South Korea achieved universal healthcare in 1989. Before that, it had many different groups providing health insurance. In 2000, a major change merged all these groups into the National Health Insurance Service. By 2004, this service became a single-payer system for the whole country.

Countries with Government-Run Healthcare

Some countries have what is called a "Beveridge Model." In this system, the government not only pays for healthcare but also owns the hospitals and employs the doctors.

Nordic Countries

Countries like Sweden, Norway, Denmark, and Finland have healthcare systems that are mostly run by the government. There is very little private health insurance. The systems are managed by regional governments, not one central government. Because of this, some people say they are not truly "single-payer" at a national level.

United Kingdom

Healthcare in the United Kingdom is managed separately by England, Scotland, Wales, and Northern Ireland. Each has its own National Health Service (NHS). The NHS is a "Beveridge Model" system because most hospitals are owned by the government and doctors are government employees.

All permanent residents of the U.K. receive public healthcare that is free when they use it. The system is paid for with taxes. There is also a small private healthcare sector for those who want it.

Countries with Mixed Systems

Some countries mix a single-payer system with private health insurance.

Australia

Australia has a public healthcare system called Medicare, which started in 1984. It exists alongside a private health system. Medicare is funded by a tax on income and other government money. It covers all the cost of care in a public hospital but only 75% of the cost in a private hospital. High-income earners who don't have private insurance pay an extra tax.

Spain

Spain's single-payer system was established in 1963. It became universal, covering everyone, in 1986. While the government pays for healthcare, it can hire private companies to manage the services. There is also a parallel private insurance system, which about 15% of the population used in 2013. In 2000, the World Health Organization ranked Spain's healthcare system as the 7th best in the world.

Single-Payer Ideas in the United States

The United States does not have a single-payer system for everyone. It has a public system called Medicare, but it is only for people over 65 or those with certain disabilities.

There have been many proposals for a universal single-payer system in the U.S., often called "Medicare for All."

Arguments for Single-Payer in the U.S.

Supporters argue that a single-payer system could save money. They believe focusing on preventive healthcare (care that prevents sickness) would lower costs in the long run. They also say it would be simpler for businesses, which would no longer have to provide health insurance to their employees.

A major concern in the U.S. is the high number of people without health insurance, which was over 27 million in recent years. Studies have shown that not having insurance can lead to worse health outcomes. Supporters also point out that high costs, like deductibles and co-payments, can cause financial problems for families.

State Proposals

Several states have tried to create their own single-payer systems, but most have not succeeded.

• California: Lawmakers passed single-payer bills in 2006 and 2008, but Governor Arnold Schwarzenegger vetoed them both. More recent attempts have also stalled.
• Vermont: In 2011, Vermont passed a law to create a system called Green Mountain Care. It was seen as the first state to move toward single-payer healthcare. However, the state canceled the plan in 2014 because the taxes needed to pay for it were considered too high.
• Colorado: In 2016, voters in Colorado rejected a proposal for a single-payer system called ColoradoCare.

Public Opinion

Polls on single-payer healthcare in the U.S. have shown mixed results. Support often depends on how the question is worded. Some polls show a majority of Americans in favor of a "Medicare-for-all" plan. Other polls show that people are happy with their current insurance and don't trust the government to run healthcare. A 2019 poll by the Kaiser Family Foundation found that 56% of Americans supported a national health plan.