How Would It Work?

Now that we've seen some examples of single-payer in action, let's look at the system for everyone as a whole--for patients, doctors, nurses, medical students, researchers, hospitals, businesses, and the health insurance industry.


Patients would have access to all medically necessary care, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. (Sorry, "medically-necessary" doesn't cover cosmetic surgery or botox injections.) Patients would have their complete choice of doctors, cheaper prescription drugs, and no bills for health care.


Doctors would have less paperwork and fewer health care headaches, but they'd also be given more freedom and choices, too. Because there would be "one form" for doctors to fill out and less time spent figuring out a patient's insurance status (and therefore more time to spend helping patients), doctors would be able to return to the reason they entered medicine--to help care for patients. Most primary care physician doctors' incomes would stay about the same (when Canada passed its health care reform, salaries actually went up). Specialists' incomes would decrease, but doctors' own costs would be decreased, too: they could spend less on office staff and employees that work on insurance claims, as well as the health insurance for those workers. Doctors would most likely see decreases in malpractice insurance premiums as well, since patients are less likely to sue if they feel like they know their doctors well, and if they know they'll have health insurance if some problem arises later.


Nurses' salaries increased greatly in Canada after passage of its health system reform. More nurses would be trained and hired to work in departments where nurses have been cut to save costs (and to work in nursing, where there is already a shortage.) This would decrease stress levels, and give nurses more time to spend caring for each individual patient.

Medical Students

Medical students would graduate with significantly less medical debt, if the single-payer plan mimicked the Canadian system. Many students cite debt (currently averaging around $90,000) as a reason they do not enter the field they truly want to enter.


Researchers would be still have their research funded like it currently is--through the National Institutes of Health, the main entity in the United States that provides research grants to professors and scientists working on science-related research.


Hospitals would all be converted to non-profit status, after a one-time payment to investors (several of the largest for-profit hospital chains have paid billions of dollars to defrauding Medicare recently). Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the single-payer to cover its expenses—a "global budget." A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc. Hospitals would no longer close because of unpaid bills.


Businesses would see the single-payer system decrease their health costs and remove the burden of administering health insurance for their employees. They would gain the competitive advantage that Canada and other countries have from decreased health costs per worker, and wouldn't need to worry about health care cost increases every year--the single-payer system helps control costs much better than the current system does.

Health Insurance Industry

The health insurance industry would be mostly eliminated--only organizations that actually employed doctors (like Kaiser Permanente in California) would be allowed to continue to operate. One single-payer bill would provide one percent of funding for retraining displaced insurance workers during its first few years of implementation.

Next: What would single-payer look like in the US?