Issue Report: Single-payer universal health care

Is single-payer health care a good idea?

Universal Health Care is the idea that health care coverage ought to be extended to all citizens and sometimes to permanent residents of a certain geographic area. The idea was first unofficially implemented in Germany by Otto von Bismarck in the 1880s. The system was first officially used in the United Kingdom in 1948. According to the Institute of Medicine and the National Academy of Sciences, the United States is the only wealthy, developed nation without a system of Universal Health Care. Almost every nation in Europe has established a system of Universal Health Care. Some states and regions can decide on their own accord whether or not they will establish some form of Universal Health Care for their citizens. The problem essentially stems from the question of whether or not the government should be hands-off in its legislation and regulation as the establishment of this system would require much of both. Proponents of a more hands-off government do not believe in Universal Health Care because they think the government should allow people to deal with Health Care as they see fit. Those who encourage at least a form of Universal Health Care are those who believe in a government’s strong obligation to its people directly through its legislations. However, while such a system has the ability to create more justice amongst social classes, it also has the ability to significantly raise taxes. Other background resources: See Wikipedia:Universal health care, See Wikipedia: Publicly-funded healthcare, Wikipedia: Single-payer health care, Canadian and American health care systems compared

Analogous services: Is universal health care analogous to other government services?

The government funds fire-stations, why not universal health care?

The government taxes citizens to fund and provide numerous services universally, including policemen and firemen. These services are comparable to physician services in many ways, particularly in the sense that they help protect the life, safety, or health of citizens. Why shouldn’t health care also be provided universally through the same means – taxes?

Health is often out of an individual's control; like fires.

You will see that the other side of this argument makes a distinction between things that an individual can control and those he/she cannot. The argument is that fire and police protection are things beyond the control of individuals, but that healthcare is not. This argument is seriously flawed. Many healthcare issues are very much out of the control of individuals. Consider a bus accident. Many accidents are out of the control of individuals. While many accidents are a result of an individual being stupid or not being careful, so are many fires. There is no real distinction here. Either you should be opposed to fire/police protection and universal healthcare, or should support both. Picking one is a logical inconsistency.

Health problems are more about individual choices than fires and crime.

While many people compare health care to police stations and fire stations, they are not the same services. Health care is largely about providing a service to the individual that compensates, often, for poor individual choices. Fire stations and police departments, on the other hand, provide services to a community and focus on protecting individuals against things they have no control over (crime and fires). The differences are very significant in regard to what the state is obligated to provide. The state is obligated to protect citizens from one-another. But, the state is not obligated to protect citizens from themselves. Universal health care is wrongheaded to the extent that it involves protecting individuals from themselves.

Whether universal health care is analogous to other services is inconsequential.

Whether universal health care is analogous or a legitimate burden on tax payers does not answer whether a universal system provides the results proponents argue.

Choice: Does universal health care deprive some choice? Is this OK?

When the wealthy must use public health care, the system improves

If the wealthy are not allowed to buy better health insurance, and are forced to use public single-payer health care, they come to realize that the only way to ensure good care is to pressure for good universal health care. As a result of the wealthy pressuring for improvements, all individuals of all classes will enjoy better health care.

Many single-payer systems give patients free choice of practitioners.

In some countries with socialized medicine, such as the UK, patients are offered a choice of general practitioner, all of whom are self-employed or work in private partnerships employing all practice nurses, doctors and clerical staff. In addition, some hospital services are sub-contracted to the private sector, so that patients can choose from a range of providers International comparisons of quality of care and health outcomes generally rank the UK above the U.S.

People have a right to pay more for better health care

Froma Harrop. "Canada's the wrong model for universal health care". Seattle Times. February 28th, 2007

“There’s also the freedom argument. People don’t want to be told that they can’t spend their own money on goods that would benefit them — and who can blame them?”

Universal health care will have rules that decrease patient flexibility

"Should the Government Provide Free Universal Health Care for All Americans?" Balanced

“Government-controlled health care would lead to a decrease in patient flexibility. At first glance, it would appear universal health care would increase flexibility. After all, if government paid for everything under one plan, you could in theory go to any doctor. However, some controls are going to have to be put in to keep costs from exploding. For example, would “elective” surgeries such as breast implants, wart removal, hair restoration, and lasik eye surgery be covered? […] The compromises that result will put in controls that limit patient options. The universal system in Canada forces patients to wait over 6 months for a routine pap smear. Canada residents will often go to the U.S. or offer additional money to get their health care needs taken care of.”

Needy: Is free health care important for those in dire need?

Free, universal health care helps the unhealthy in times of need.

When an individual is sick, they shouldn’t have to think about how to pay for their treatment. In free, universal health care systems, when one is sick, they are simply told to rest and get better. This is essential for proper healing. Conversely, in a non-free-universal-health-care system, a sick person is required to figure out how to pay for their health care, rather than simply focusing on getting better. The stresses this causes hampers healing.

It is wrong to make more vulnerable people pay more for insurance

The modus operandi of the insurance industry is that the vulnerable (people of higher risk of becoming ill) pay more for health insurance. But, this is unfair and contrary to the higher moral principles upon which societies should be founded. Society should strive to defend and care for the needy and vulnerable, instead of subjecting them to a system that punishes them for their disadvantages.

Unacceptable to leave health care of millions to rare charity orgs/docs.

It is morally unacceptable to leave the health care of millions of American who cannot afford to pay insurance to the hands of the few rare doctors and charity health care services. Also, charity health services would not have enough equipment and funds to treat expensive, life-threatening diseases like cancers.

Single-payer systems make it harder to get care when it's most needed

Delays are a common feature of single-payer systems. This means that, when a person is sick and most needs an appointment, they may be unable to get one.

A right to health care is not necessary in taking care of sick patients.

Indigent patients have been taken care of by physicians with dignity and compassion in the name of genuine charity, pro bono. This model can provide adequate care to the needy. And, of course, this model can be expanded out further, if need be, to aid the needy.

Human rights: Is health care a human right?

Health care is a basic human right or entitlement

Health is fundamental to the preservation of all other individual rights. If one is sick in a hospital bed, they cannot be said to have equal opportunity or the ability to exercise free speech and religion. And, of course, one cannot pursue happiness if they are in a hospital bed. This is why health must be considered a basic human right.

Universal health care protects healthy citizens from many health risks.

If citizens have a right to be healthy, they are due some protections from the sickly. By providing for the sickly, government is helping protect the rights of the healthy.

Health care is considered a right in international law.

Article 25

of The UN Universal Declaration of Human Rights enumerates medical care as a universal right.

Universal health care is a social good, not merely an economic good

Universal health care generally decreases human misery and increases human welfare. It is, therefore, a social good, not merely an economic good. In general, the ability to afford something does not play a role in whether it is just or not. If there is a conflict between life and money life should prevail because it is a right while money is a want not a need.

Universal health care is a legitimate "burden" on the tax payer.

People pay for public utilities such as road and people pay for education as well. But do people who don’t drive recklessly ask for money back when roads are damaged? Do people who send their children to private school ask for all their money back? We place this burden on the state because of equality of opportunity. No man should be denied the right to live his life.

Universal healthcare helps foster greater equality across classes.

In the United States, the poor commonly cannot afford health care. Universal health care helps them get the care that they need. Without health care, the poor are more vulnerable and have a harder time achieving their goals. This violates their right to equal opportunity.

Universal health care violates individual freedom and responsibility

It is important that individuals be treated as free moral agents, accountable to their own actions, and not held accountable to the actions of others. Universal health care holds some individuals accountable for the actions of others.

Free, universal health care is an illegitimate "positive" right

The main premises here is that “rights” should only protect individuals from harm from others and allow them certain freedoms, but a right to universal health care entails individuals burdening other members of society (possibly violating the liberties of innocents) for things that are perceived as needed or desirable. The extreme of this argument is the circumstance in which a careless smoker is given the “right” to burden others for their expensive health care costs.

The necessity of medical care does not make it a right.

Food, for example, is not considered a right, and companies are allowed to sell it, as well as to withhold it from those that need it but can’t afford it. This is the right of grocery stores to do, and receives no complaint from society in general.

People leading healthy lives will be burdened by the unhealthy

It is not fair for those that lead healthy lives to have to pay for those that lead unhealthy ones. Those that make decisions to smoke cigarettes and eat excessively should pay the consequences.

People should pay only for health services they themselves receive

Why should one person pay for the health services of another person? With the possible exception of life-threatening circumstances; isn’t it better that individuals pay for the services they receive.

Securing a "right" to universal health means impeding on other rights

Providing universal health care means increasing costs to certain taxpayers. This in itself impedes on certain freedoms and rights. Securing one right by impeding on other is illegitimate.

Universal health care systems suffer from inequality of care

Some studies have found that universal health care systems are vulnerable to socio-economic inequalities in the care provided.

Government-funded universal health care would violate patient privacy

Sue Blevins. "Universal Health Care Won't Work -- Witness Medicare". Cato Institute. 2001.

“Currently, many Americans choose to pay privately for health services to maintain their medical privacy. However, a single-payer health plan would eliminate that option and all citizens would be forced to give up their ability to maintain a confidential doctor-patient relationship. Just look at what has happened with Medicare.

Whether health care is a right under i-law is inconsequential.

he mere act that a UN body on Human Rights has added that to their charter is not definitive of anything. Using it as an argument fails as it’s only an appeal to authority.

Whether universal health care is a legitimate "burden" on the tax payer should be considered inconsequential.

Since health care is currently 1/7th of the US Economy, simply asking whether the tax payer can be burdened to help provide others with health care does nothing to ask whether allowing more government control will end with the results proponents predict.

Whether universal health care is a social good is inconsequential.

Again, this question’s answer has no bearing on whether a universal system can provide the level of service proponents claim.

It is impossible to answer whether universal health care fosters greater equality.

Since the word equality necessitates a value judgment as to what is “equal” when it comes to health care and class status, a universal definition is not possible. For instance – would it be equal if no one had access to MRI’s? If only 80% of those requiring an MRI could get it – what would determine how to define those individuals “equally”?

Government-funded universal health care is no right

Anthony Randazzo. "Questioning the "Right" to Health Care". Reason Foundation. 2009.

“People sometimes argue in favor of a universal human right to health care by saying that health care is different from all other human goods or products. It is supposedly an important precondition of life itself. This is wrong: There are several other, much more important preconditions of human existence, such as food, shelter and clothing….”

Uninsured: Do large numbers of uninsured give cause to universal health care?

Most uninsured simply can't afford it; it's not a choice

Kao-Ping Chua, "Arguments and counterarguments about universal health care". AMSA

“It’s the uninsured’s fault that they’re uninsured. 8 out of 10 of the uninsured work or come from working families. They play by the rules, work hard just like the rest of Americans, and yet they can’t get insurance from the employer because it’s not offered, or they can’t afford it if it is offered. Is that their fault?”

Universal care would protect doctors/hospitals from free-loaders

Uncompensated care is a problem for hospitals and doctors. In a single-payer system, doctors would not be vulnerable to free-loading (as rare as willful free-loading is).

Universal health care is not welfare; its benefits are diverse/widespread

Universal health care is about cutting costs, streamlining patient care, simplifying care, and providing high quality health care to all citizens. The benefits are far to diverse to pigeon-hole universal health care as just “welfare”.

It is a myth that the uninsured are being provided for now

While some argue that the uninsured being provided for currently with access to emergency rooms and social programs, it is false to claim that this is a substitute for these individuals actually having health insurance.

The well insured also face risks without universal health care

The uninsured are not the only concern when a society lacks universal health care. The insured are subject to major costs and risks, for instance when they are fired from a job and lose their employer-provide health insurance.

If people are uninsured, that's their choice

"Against Universal Coverage". National Review Online. June 21, 2007

“Some people, especially young and healthy people, may choose not to buy health insurance even when it is cheaper[…]So what should the government do about the holdouts? Leave them alone. It’s a free country.”

Many uninsured are lazy free-loaders who don't deserve care

Many uninsured are simply lazy, and believe they can get a free ride off of the system. These people do not deserve free, universal care from the system.

Universal health care would amount to welfare for the uninsured.

The government should not create a health care system that is aimed primarily at helping the poor and uninsured. As such, it becomes merely another wealth-transfer program.

Many uninsured can easily afford it so should not receive sympathy

A significant proportion of the uninsured can easily afford insurance. They choose not to get it for reasons other than their means (i.e., their laziness).

The uninsurance problem should be solved by less, not more government

Lawrence R. Huntoon, MD, PhD. "Universal Health Coverage --- Call It Socialized Medicine". Association of American Physicians and Surgeons. 2000.

“Collectively, the uninsured pay about $17.1 billion in extra taxes each year because they do not receive the same tax break as insured people with similar income… Where, we must ask, is the compassion for these overtaxed, hard-working people? This is clearly a government-created problem. What we don’t need is more government (nationalized health care) to “fix it.” What we need is to get government out of our wallets so people can have their own money needed to purchase and own their own health insurance.”

Do large numbers of uninsured give cause to universal health care?

No, as it does nothing to answer how many would be without in a hypothetical universal system. For instance, what if we knew that instead of 50 million uninsured, we would end up with 60 million uninsured due to additional inefficiencies and failure to predict actual cost?

Socialized medicine: Is it wrong to call single-payer systems socialized medicine?

Single-payer systems involve government paying for private services

Most single-payer systems in Europe, as well as ones proposed in the United States (building on Medicare), involve the government paying for the insurance of individuals. This means that individuals would still go to private hospitals and doctors. The only difference is that the government-funded insurance pays for services instead of the money coming from your own insurance company.

Rationing already exist in the US; universal health care won't change this

"Single Payer FAQ". Physicians for a National Health Program. Retrieved May 30th, 2008

“The U.S. already rations care. Rationing in U.S. health care is based on income: if you can afford care, you get it; if you can’t, you don’t.”

A single-payer system will not cause government to intrude in medical decisions

There is nothing in universal health care that would indicate that the government would intrude on the medical decisions of citizens.

Single-payer health care is "socialized medicine"

Lenin said, “medicine is the keystone in the arch of socialism.” Government should not be in control of medicine and should generally not be in too many features of our lives. It is both inefficient and an intrusion on our fundamental rights.

Universal health care leads to rationing.

Medical resources are rationed in socialized systems so that some people are either denied care or have to wait for it. If a person is “rationed out” of the public health care service (perhaps because the treatment is not considered effective or cost effective enough to warrant intervention) they will be able seek alternative treatment in the private sector. If they cannot afford private care, they may have to go without.

Government intrudes in medical decisions in a single-payer system.

Government will involve itself in decisions between doctors and patients under a single-payer system.

Universal health care creates dependencies on government

Whenever the government provides free services to individuals, a dependency is created. Dependency is an unhealthy mind-set, and can cause problems down the line.

"Is it wrong to call single-payer systems socialized medicine?" is another inconsequential question.

It’s answer is meaningless to which system provides the most benefits to the most people. It’s a semantic argument which will hang more on specific definitions or words that anything resembling rational health care debate. Having said that – the answer is “yes”. Socializing anything involves taking individual decisions and “socializing” any negative effects to the community instead of limiting it to the individual.

Physicians: Is free, universal health care fair to physicians?

The majority of doctors in the US support universal health care

A 2008 survey of over 2,000 American doctors found that 59 percent support legislation to establish a national health insurance program, while 32 percent said they opposed it, researchers reported in the journal Annals of Internal Medicine[1]

Universal health care can actually strengthen doctor pay

If there are more insured patients within a universal health care system, more people will seek health care. As such, there will be more paying patients in a universal health care system, which will result in more income for doctors. Doctors will also spend less time on paper work, be more efficient, service more patients, and so make more money.

Single-payer systems insure individuals, but don't restrict doctors

A universal health care system does not mean that the private market should be abolished. Doctors can chooses to operate private practices in a two-tier system. This will attract consumers who require either more personal service, those who know or want a personal doctor, and those who want better quality of care than the public system provides.

Universal health care grounds doctors in professionalism, not commercialism.

Doctors are currently businessmen that sell health services. But, realizing that this is not a good model for dealing people’s lives and health, many doctors see universal health care as a way to better root their profession in professionalism instead of this commercialism.

A right to health care violates the rights of physicians

One cannot have a right to other people’s services. Does a physician not have the free right of association and contract with patients? Why would physicians be forced to perform free or government-set prices for their labor? Why shouldn’t they be able to charge market value for their services? Did they enter into their practices with the understanding that they would not be able to charge fair market value? No. They are generally service providers like any other that expect fair, market-based compensation. Universal health care would deprive physicians of this freedom to charge market-value by imposing government pricing on their services, almost certainly at a discounted rate.

Universal health care will cut physician cash-flow and disrupt living-standards.

It is important to recognize that many private physicians have oriented their private practices around a certain level of cash-flow. They have rented office space at a certain level, taken out mortgages at a certain level, and sent their kids to private schools all on the assumption that their existing cash-flow in their private practices would continue into the future. It is unfair to suddenly and dramatically curtail this cash-flow and force physicians to re-adjust their lives accordingly. For some, this will be impossible or unbearable.

Universal health care would lower rewards so reduce quality of physicians

With fewer financial incentives, fewer individuals would decide to become physicians in the first place. Talent would be lost from the industry and the quality of doctors and health care would fall.

Single-payer health care over-loads doctors and burns them out

Because more people seek care, doctors in a universal health care environment often are over-loaded. Hoping to meet their patients needs, they work over-time. Yet, by doing this, they often burn out and leave their practice early, exacerbating the problem even further.

Quality: Does free, universal health care provide superior care?

For-profit insurance companies often put patients at risk to cut costs

Health insurance claims are considered a “loss” for profit insurance companies. These companies are designed to maximize profits by cutting costs. How can these companies act in the best interests of their patients if their incentive structure is designed to minimize health coverage?

Insurance companies screen out those that need health care the most

Insurance companies have a interest in maximizing profits that drives them to screen out individuals that are unhealthy, old, and “high-risk”. These are the people that need health care the most, and the insurance industry has a direct interest in making it difficult or more expensive for them to obtain health insurance.

Universal health care systems incentivize improving patient health.

Many free universal health care systems provide incentives to doctors to improve the health of their patients. This contrasts with for-profit health care systems that do not provide financial incentives to doctors to improve the health of their patients, largely because healthier patients would mean lower profits.

Universal health care will allow doctors to concentrate on patients

In private and managed health care networks, doctors typically have to check with insurance companies before they perform a service. Such a system does not relate to the patients needs, but corresponds only to financial considerations.

Universal health care allows investments in longer-term patient relationships.

This happens because there is a long term relationship with the patient and the preservation of records has long term benefits. Investment in IT is one often cited example where health care providers in socialized systems have access to electronic records of patients tests online and where computer systems can check for example incompatible drug combinations and that drugs are administered to the right patient. Some for profit systems find this investment hard to justify because the provider-patient relationship is not guaranteed to last long enough to justify the investment.

Universal health care decreases the likelihood of health related problems.

The single most destructive issue regarding health care in America is the lack of preventative care. Patients wait until their disease progresses to a dangerous level before they seek care because otherwise they can not afford medical cost. Universal health care offers them access, thus increasing the patient’s incentive to seek care when the health threat is minimal, and in the long run reducing the burden to the state.

The markets are better at providing quality; same with health care.

The markets and competition generally help produce higher quality goods for the least money (the highest value). The same applies to health care.

Government-mandated procedures would reduce doctor flexibility/quality

"Should the Government Provide Free Universal Health Care for All Americans?" Balanced

“Government-mandated procedures will likely reduce doctor flexibility and lead to poor patient care. When government controls things, politics always seep into the decision-making. Steps will have to be taken to keep costs under control. Rules will be put in place as to when doctors can perform certain expensive tests or when drugs can be given. Insurance companies are already tying the hands of doctors somewhat. Government influence will only make things worse, leading to decreased doctor flexibility and poor patient care.”

Quality of health care is much worse under universal health care.

According to Reuters in London, one in 10 patients admitted to National Health Service hospitals in Britain is unintentionally harmed and almost a million safety incidents, more than 2,000 of which were fatal, were recorded last year, according to a report on July 6, 2006. Such figures were “terrifying enough”, the report by parliament’s public accounts committee said, but the reality may be worse because of what it called “substantial under-reporting” of serious incidents and deaths in the NHS

IT investments do not require government intervention.

Some have argued that IT enhancements in a universal system will provide efficiency improvements. Most technological advancements which includes universal IT standards for online financial transactions, messenger protocols, FTP protocols, and many, many others have been standardized within the industries without government intervention.

Lack of preventative care does not significantly contribute to life expectancy or quality of life.

Most of what determines length and quality of life (excluding human issues such as traffic accidents, homicides…) is genetics and life style choices (eating/exercise). Early detection will certainly weigh heavily on life expectancy for certain diseases, but no amount of “prevention” will stop cancer if you genes are highly susceptible. As most people know, most doctor’s visits end with “take this and call me if it doesn’t get better” which should hardly be seen as “preventative” of anything.

Prevention: Is free universal health care important to preventive care?

Free universal health care motivates people to seek preventive care

Preventing illnesses before they arise is a very important strategy in public health. Universal health care encourages people to seek preventive treatments because it is free. This cuts health care costs substantially down the line.

Government has a cost incentive to invest in preventive care

Paul Krugman, Robin Wells. "The Health Care Crisis and What to Do About It". New York Times Review of Books. Volume 53, Number 5 · March 23, 2006

“The VA also invests heavily and systematically in preventive care, because unlike private health care providers it can expect to realize financial benefits from measures that keep its clients out of the hospital.”

Better technologies and treatments in private health care aids prevention.

Private health care societies are known for having better innovation and higher investment in equipment and high-end treatments. These treatments can be a part of prevention or early treatment, and can have better results than what exists in universal health care systems.

Higher-end treatment is important; sometimes you can't prevent illness.

With higher-end treatments in privatized health care societies, treatment is often superior. For those that will contract illnesses or cancers regardless of any preventative measures they take, such high-end treatment is welcome.

To access the second half of this Issue Report or Buy Issue Report

To access the second half of all Issue Reports or