What is Single-Payer Healthcare?

Healthcare involves two main steps: financing and delivery. Under a single-payer system, also known as “universal healthcare,” everyone receives healthcare coverage under a single insurance plan financed by public taxes. However, the delivery of care can occur through private or public providers.


Key Takeaways

  • Single-payer healthcare systems cover all citizens under one health insurance plan.

  • Single-payer systems don’t need to be managed by a centralized agency.

  • While the Affordable Care Act of 2010 took serious steps to expand healthcare access, it isn’t a single-payer model.


What is Single Payer Healthcare

Envisioning Single Payer in the U.S. 

In the U.S., a single-payer healthcare system would offer the same insurance plan to all citizens. The plan would cover all medical care and would be publicly funded through taxes. People also would no longer have to pay premiums for health insurance.

Some History For Ya

Single-payer healthcare reform in the U.S. has a long history. In the 1940s, President Harry Truman envisioned a universal health insurance plan funded by payroll taxes, which paved the way for the creation of Medicare and Medicaid in 1965. In the early 1970s, Senator Ted Kennedy and House Representative Martha Griffiths advocated for a national healthcare program to replace all existing healthcare plans, but it was suppressed by the private health insurance industry. More recently, the Affordable Care Act of 2010 significantly expanded access and affordability of health insurance for the uninsured, but ultimately conformed to the multi-payer environment of the U.S. 

Pros & Cons

Under a single-payer plan, insurance premiums wouldn’t exist, and patients would no longer face cost-sharing expenses (deductibles, copays, coinsurance). Patients would have true freedom when selecting providers, and a lot of the bureaucratic and administrative clout that plagues American healthcare today would be eliminated.

While the pros of a single-payer system are compelling, so too are the cons. A publicly-funded healthcare system would face intense opposition from organizations like insurance companies, whose bread and butter is healthcare spending. A single-payer system would also involve tax increases that would offend anti-tax public opinion. In addition, many citizens may oppose the idea of total government control over healthcare, despite existing examples of successful foreign single-payer systems from our friends in Europe and other areas of the world.

Institutional barriers would also limit this transition. The upfront costs of transitioning to a single-payer system are unpopular with the public, despite the greater long-term savings projected from moving to a single-payer system.

Looking Forward 

While the Affordable Care Act helped improve certain aspects of health insurance coverage, the U.S. still remains the only high-income nation without universal health coverage. In studies evaluating healthcare performance between different countries, the U.S. consistently ranks last, despite spending the most on healthcare. Clearly, there is a fundamental issue with the U.S. healthcare system, and a single-payer system may be a viable solution.


Outside the Huddle


Reviewed by Geetika Rao, MPH | Edited by Nidhi Mahagaokar, MPH and Jared Dashevsky, M.Eng. | Fact checked by Julia Radossich, PA-C