Single Payer

Key Questions

What is the Policy Problem?

The U.S. health care system is the most expensive in the world, yet leaves 47 million uninsured, is very complicated and has high administrative costs and excess profits. Single payer advocates believe that universal coverage could be achieved far more simply and at a lower cost than today’s system or alternative approaches to reform. See Why US Needs a Single Payer System (PNHP) for details.

What are the Policy Options?

Single payer proposals fall into three major categories:

UK-style National Health System

Canadian-style Single Payer. This approach is best illustrated by the proposal supported by PNHP:

  • Coverage. A single public plan would cover every American for comprehensive medically-necessary care (including long-term care, mental/dental health). Boards of expert and community representatives would assess which services are unnecessary or ineffective, and exclude them from coverage. Private insurance duplicating the public coverage would be proscribed. Patient co-payments and deductibles would be eliminated.
  • Payment for Hospital Services. The NHI would pay each hospital a monthly lump sum to cover all operating expenses – that is, a global budget. The hospital and the NHI would negotiate the amount of this payment annually, based on past expenditures, previous financial and clinical performance, projected changes in levels of services, wages and input costs, and proposed new and innovative programs. Hospitals would not bill for NHI-covered services. Hospitals could not use any of their operating budget for expansion, profit, excessive executives’ incomes, marketing, or major capital purchases or leases. Major capital expenditures would come from the NHI fund, but would be appropriated separately based upon community needs. For-profit hospitals would be converted to not-for-profit status, and their owners compensated for past investment.
  • Payment for Physicians & Outpatient Care. The NHI would include three payment options for physicians and other practitioners: fee-for-service; salaried positions in institutions receiving global budgets; and salaried positions within group practices or HMOs receiving capitation payments. Investor-owned HMOs and group practices would be converted to not-for-profit status. Only institutions that actually deliver care could receive NHI payments, excluding most current HMOs and some practice management firms that contract for services but don’t own or operate any clinical facilities.
  • Medicare for All

See What is Single Payer? (PNHP) for details.


Fast Facts


Best of Web


  • Physicians for National Health Program (PNHP). PNHP is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 16,000 members and chapters across the United States.





One Response to “Single Payer”

  1. Emmanuel Anderson (@borglepdo1971) Says:

    I suspect that things will not change until the People start to question and challenge the status quo.

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