How Would It Work?

Single-payer national health insurance would provide health insurance coverage for everyone in the United States (the US currently has about 45 million uninsured), alter the way businesses pay for health care, modify how doctors are paid, how hospitals calculate their costs and budgets, and how much prescription drugs cost in the United States. Let's look at a couple of stories from average patients and health care workers to give a couple examples of how a single-payer system might work in the United States. Then we'll break it down by group by group--and give an overview of how patients, physicians, businesses, hospitals, and insurance companies would end up in the single-payer world.

Eric Flores

Eric sells computer parts for a large technology company in Texas. He currently has health insurance for himself, but for the past two years, his employer has been making him pay for more and more of the health care bill. And the insurance covers his wife, but not his kids. Eric's not happy about it, but what's he going to do?

In a single-payer system, Eric's employer would most likely have to pay less for his health insurance--meaning Eric would take home more of his paycheck every month. There would be a small income tax to help pay for the system (smaller if he makes less money, larger if he makes more), but Eric's kids would have full health insurance, would likely never see a bill again, have cheaper prescription drugs, and no huge deductible if he ever got really sick. He could go see any doctor he wanted, and would have health care even if was laid off or went on a vacation to Florida.

Joanna Edwards

After 15 years of working in a factory in New Jersey, the factory closed, leaving Joanna jobless--and without health insurance. She recently found some part-time work, but it doesn't offer her health insurance. She's healthy and fit, but her daughter has asthma and needs to see a doctor regularly. She's tried to buy health insurance as an individual, but everyone denied her because of a dislocated shoulder 5 years ago in a minor car accident (yes, this is actually cited as a "pre-existing condition.")

In a single-payer system, Joanna and her daughter would both be covered. There are no "pre-existing conditions;" there are no rejections of coverage. Even after she lost her job, she could still take her daughter to the same doctor and her daughter could still get the medicines she needs to keep from having an asthma attack.

Daren Yu

Daren runs a small business in California. He has 4 employees, and business is stagnant, but he still can't afford to provide health insurance for his employees. He's purchased health insurance for his wife and three children, costing over $400 a month, but for the last 2 months he couldn't afford to pay the bill, and he lost his coverage. His wife was just diagnosed with breast cancer, and he's worried about his wife's treatment and that he may have to sell his business or risk going bankrupt.

Daren's not alone--today in the US, 45% of bankruptcies are due to medical costs and debt. And he can't get any of those $400 payments back, even though he's now uninsured and his wife needs care. But single-payer would change that. As an employer, he would pay a payroll tax to help pay for the new health care system (again, the amount based on how much his company makes). As a husband and father, his wife would receive the treatment she needed for her breast cancer without additional costs (besides the sliding-scale income tax). This is how insurance normally works--everyone pays into the system, so that when you're well, you're helping pay for those who are sick, and when you're sick, others are paying to help cover your costs.

Next: How single-payer would affect all the health care players...