The American Public Health Association Endorses Single-Payer Health System Reform

Abstract

Health care is a human right. Achieving universal health insurance coverage for all US residents requires significant system-wide reform. The most equitable and cost-effective health care system is a public, single-payer (SP) system. The rapid growth in national health expenditures can be addressed through a system that yields net savings over projected trends by eliminating profit and waste. With universal health insurance coverage through SP financing, providers can focus on optimizing delivery of services, rather than working within a system covered by payers who have incentives to limit costs regardless of benefit. Rather, with a SP, the people act as their own insurer through a partnership with provider organizations where tax dollars work for everyone. Consumer choice is then based on the best care to meet need with no out-of-pocket payments. SP financing is the best option to ensure equity, fairness, and public health priorities align with medical needs, providing incentives for wellness. Consumer choice will drive market forces, not provider network profits or insurer restrictions. This approach benefits public health, as everyone will have universal access to needed care, with treatment plans developed by providers based on what works best for the patient. In 2021, the American Public Health Association adopted a policy statement calling for comprehensive reforms to implement a SP system. The proposed action steps in this policy will help build a healthier nation, saving lives and reducing wasted health care expenditures while addressing inequities rooted in social, demographic, mental health, economic, and political determinants.

The Economic and Social Impacts of Providing Universal Healthcare in the United States: A Rapid Scoping Review

“…Other estimates included a reduction of administrative costs of 7% for hospitals, 4% − 11% for physicians, and 3% for other medical providers (17,52). Another area where savings may be realized is through reduced prescription costs through negotiated prices; with estimates of around $180 billion savings (3,4,13,19,23,47,49).…”

“…Putting off care is associated with higher costs I the future so ensuring individuals can access care sooner reduces these excess costs (9,23). Delay of care due to cost controls, such as long wait times, is also associated with higher expenses so cost controls must take this into account (53).…”

The Economic and Social Impacts of Providing Universal Healthcare in the United States: A Rapid Scoping Review

“…The literature varied on assessment of universal healthcare's impact on national health expenditures. The exact impact is dependent on the plan (4) with some reducing costs (1,17,23,46,47), some increasing costs (22), and some increasing spending in the short term but realizing net reductions in spending after a few years (13,23,48,49). Overall, most plans realized signi cant reductions in healthcare spending -one estimate projected a 13% reduction from current spending, the equivalent of more than $450 billion per year (1).…”

“…The literature discussed the impact of various types of healthcare systems on healthcare costs and the cost control measures needed to balance cost increases and cost savings. Cost controls include supply side controls (e.g., not increasing physicians or hospital beds) (13,47), negotiated prices for prescriptions and medical equipment (23,46,48), setting of provider reimbursement rates (4,22,48,49), and policies to reduce fraud and waste (50).…”

“…The primary offset to increase utilization discussed was that a single payer system would signi cantly reduce administrative costs through simpli cation (4,9,13,17,19,23,27,28,36,38,43,46,49,50). Estimated administrative savings ranged widely, from 1.2% to 20% of healthcare spending (19,36,49).…”