frequently asked questions
2. Why not just defend the Affordable Care Act?
3. What’s wrong with a “public option” or lowering the age for Medicare to 55?
4. Is this “socialized medicine?”
5. Don’t Canadians come to America for health care because they dislike their single payer program?
6. Didn't Vermont and other states refuse to implement single payer because it was too expensive?
1. What is “Single Payer?” Single-payer health insurance is also known as, "improved Medicare for All." It is a system in which a single public agency handles health financing (instead of multiple health insurance companies) and delivery of care remains largely private. Under a national single-payer system (HR 1976 and S 1804), all Americans would be covered for all medically necessary services, including doctor visits, hospital stays, preventive care, long-term care, mental health care, reproductive health care, dental and vision care, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care. Since it is unlikely single payer legislation will pass at the federal level, Rhode Island can and must act at the state level and pass H. 5628 and
S. 0233 or at least pass legislation establishing a study commission H. 5019 and S. 230
2. Why not just defend the Affordable Care Act? Fully implemented, the ACA continues not to insure 2.9% of Rhode Islanders (29,000 people) and about 28% are under-insured. See here. As a result, about 29 Rhode Islanders or more likely die every year because they lack appropriate medical insurance. The ACA also lacks a mechanism to control medical costs. Between 1991 and 2014, health care spending in RI, per person, rose more than 250%. The Congressional Budget Office notes that even with the ACA, the Average Annual Worker and Employer Premium Contributions for Family Coverage, in 2023 was about $24,000, roughly one-third of the average Rhode Island family’s income. Moreover, the ACA cannot prevent private insurers from limiting both providers and coverage.
3. What’s wrong with a “public option” or lowering the age for Medicare to 55? For more detailed myths and facts about the public option, click here. Basically, the public option leaves the country’s health care system with multiple payers and loses single payer efficiency and cost savings. Also, the public option retains the risk of private insurance companies keeping the healthiest patients ("cherry picking") and forcing Medicare to take elderly and sick patients ("lemon dropping"). In 1972, for example, private insurance successfully got renal dialysis patients to be covered by Medicare regardless of the age of the patient. This shifted a huge number of chronically ill patients from private insurance to Medicare. As for lowering the age of Medicare coverage, this will also continue to leave private insurance companies in place to "cherry pick" and "lemon drop" patients. Along with continuous cuts to Medicare funding, the false perception is created that the government cannot run a successful health insurance program.
4. Is this “socialized medicine?” No. Socialized medicine is a system in which doctors and hospitals work for and draw salaries from the government. RICHIP would use private doctors and hospitals like Medicaid and Medicare do.
The proposed single payer bills, S. 1655 Medicare for All Act 2023 (Sanders) and H. 3421 Medicare for All Act 2023 (Jayapal)would pay for care provided in the private (mostly not-for-profit) sector. This is similar to our Medicare program: doctors are in private practice and are paid on a fee-for-service basis from government funds; the government does not own or manage medical practices or hospitals.
Great Britain and Spain have socialized medicine programs but most European countries, as well as Canada, Australia and Japan, have socialized health insurance rather than socialized medicine.
5. Don’t Canadians come to America for health care because they dislike their single payer program? This myth runs counter to all available data, but is continually put forth by those who benefit from protecting the current multi-payer system. A study in 2012 showed that the top 600 US hospitals cared for a total of 800 Canadians that year; of that number, 80% received care because they fell ill or were injured while travelling in the United States. Health care in Canada costs about one-half per capita as in America, and overall, Canadians get better care with better outcomes. Canada has had its single payer system since 1972 without major changes.
6. Didn't Vermont refuse to implement single payer because it was too expensive? No. The Vermont plan, known as Green Mountain Care, was not a single-payer plan. The ultimate design for GMC retained multiple payers, and would have continued to pay hospitals and other institutional providers on a per-patient basis, perpetuating the expensive billing apparatus that siphons funds from care. Hospitals would have continued to rely on surpluses from day-to-day operations as their main source of capital funds, forcing hospital administrators to identify and pursue profit opportunities. Single payer pays hospitals via lump-sum budgets with separate grants for capital costs. Even so, it was political will, not cost, that defeated the Vermont health reform. The health exchange the state set up under the ACA didn’t work (as happened in several other states as well), draining political capital, and the governor barely squeaked through his re-election. A contributing factor was that the financing plan developed by the governor’s own team was not very progressive or diversified. Finally, making formerly hidden health care costs transparent by replacing them with taxes, even if the taxes are lower, is a heavy political lift. In sum, what stopped single payer in Vermont were political and institutional obstacles, not economic ones. See this article for details.