How Single-payer Stacks Up: Evaluating Different Models of Universal Health Coverage on Cost, Access, and Quality

Abstract

Described as "universal prepayment," the national health insurance (or single-payer) model of universal health coverage is increasingly promoted by international actors as a means of raising revenue for health care and improving social risk protection in low- and middle-income countries. Likewise, in the United States, the recent failed efforts to repeal and replace the Affordable Care Act have renewed debate about where to go next with health reform and arguably opened the door for a single-payer, Medicare-for-All plan, an alternative once considered politically infeasible. Policy debates about single-payer or national health insurance in the United States and abroad have relied heavily on Canada's system as an ideal-typical single-payer system but have not systematically examined health system performance indicators across different universal coverage models. Using available cross-national data, we categorize countries with universal coverage into those best exemplifying national health insurance (single-payer), national health service, and social health insurance models and compare them to the United States in terms of cost, access, and quality. Through this comparison, we find that many critiques of single-payer are based on misconceptions or are factually incorrect, but also that single-payer is not the only option for achieving universal coverage in the United States and internationally.

Long COVID and Health Inequities: The Role of Primary Care

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Political Economy of Reform under US Federalism: Adopting Single-Payer Health Coverage in New York State

“…Additionally, loss of choice and increased wait times are further caricatures of single-payer that are easily exploited to dampen support, even though crossnational comparisons do not bear this out. 35 Thus, the strategy of the opposition is to paint the reform team as unrealistic and fiscally irresponsible.…”

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“…[14] Given the performance of single-payer models showing consistently stronger results across multiple dimensions of healthcare, it is a viable reform option for the U.S. to explore. [15] The COVID-19 pandemic that began in early 2020 has had a deleterious effect on healthcare, notwithstanding a tremendous financial impact on healthcare systems. [16] The pandemic's full impact remains unknown, however the traditional fee for service and payment models come under additional stress and scrutiny as a result.…”