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How exactly would single-payer health care work?

Sanders health care
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Whether you call it single payer or Medicare for all, the idea of a government-sponsored universal health care system, no matter how contentiously debated, continues to infiltrate the health care discussion.

The idea of universal health care reemerged during the 2016 presidential primary campaign as one of Bernie Sanders' main platforms. In September, Sanders, I-Vermont, introduced a "Medicare for All" bill into the Senate with the full knowledge it would likely go nowhere -- for now. In August, Rep. John Conyers, D-Michigan, reintroduced an expanded and improved Medicare for All bill in the House.  

Both bills would convert the current many-payer system -- insurance companies, states, the federal government -- into a government-sponsored, tax-supported health care system. As in many other countries, every US citizen would receive health care, and it would essentially be paid for by one source, the government.

In addition to these national legislative moves, which may be more symbolic than realistic, at least three states have been working toward a single-payer system, and those efforts can also help consumers understand how such a plan would work.

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The most recent effort toward that goal came from the Massachusetts Senate early in November. Already known for its progressive health care policies, the state approved a broad health care reform bill that seeks to lessen price disparities between hospitals, address rising drug costs and lower the number of patients readmitted for hospital care within 30 days of a discharge.

An important amendment to the bill called for a study of what it would cost Massachusetts to implement a government single-payer health care system. The amendment, introduced by Sen. Julian Cyr, a freshman Democrat, passed by a surprising 33 to 6 vote. "When you consider every other developed nation has single-payer health care, we've just got to look at this," said Cyr. 

In addition, he pointed out that Massachusetts is a state that spends one of the highest amounts per capita on health care. Thus, it only makes sense to find out if that money could be spent more equitably and efficiently with a single-payer system.

Other states grappling with this issue haven't been entirely successful. Back in 2011 Vermont was the first state to implement a universal health care system of its own, in which all citizens were insured under Green Mountain Care. But by 2014, the state abandoned its efforts, citing unmanageable higher taxes. 

Now Vermont is moving toward an alternative system that offers health care providers lump sum payments that are designed to reward doctors for keeping patients healthy instead of solely treating illness.

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California, however, may have had the country's most ambitious plan for single-payer health care. Such a plan passed the Senate in June but was then stalled in the summer because of the potential increase in taxes and the lack of analysis on how the bill would be funded. The debate continues.

When asked in a recent interview on NPR if state efforts are the shortest way to get to a single-payer system, Linda Blumberg, senior fellow in the Health Policy Center at the Urban Institute, said implementing single-payer health care state-by-state may be far more difficult than a federal system. "High-income states that have a lot of private health care spending … are most likely to be able to do something like this," she said. But other states without resources can't just shift costs from one side of the ledger to the other, she added.

In the meantime, pundits such as Drew Altman, president and CEO of the Kaiser Family Foundation, have other warnings about a national single-payer system. Most people worry about the increase in taxes a single-payer system would cause, Altman has written. But also, most people don't realize they would need to change providers under a single-payer system, something that has always been complicated and uncomfortable for consumers.

For the moment, how single-payer would work is anyone's guess. It may take months or years to answer these questions. But the earlier consumers can be aware of the issues involved in a big change like this, the better. 

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