Single-Payer and Universal Health Care

Citizen-led efforts to institute more universal health care programs are cropping up across the country.

Some are very similar to the Canadian health care system. They call for a single-payer system, meaning that medical care would be paid for out of a single publicly administered pool of money, rather than by myriad managed care plans. In most plans the health insurance program would be administered by a health care “trust,” governed by a combination of stakeholders, including health care advocates, providers, organizations and experts, taxpayer representatives, and state officials.

Providers would still charge on a fee-for-service basis, with fees determined through negotiations between these stakeholders. Patients would still have the freedom to choose their health care provider. “Medically necessary” care would be covered. Many plans have some sort of sliding premium scale, whereby the poorest residents of the state would pay no health care taxes, and the wealthiest residents would pay the most.

Here we highlight some single-payer and universal health care initiatives that have been introduced or put in place.

More Information:

Health Care Act – New Mexico

Twenty-two percent of New Mexicans had no health insurance in 2003, compared to about 16 percent nationwide. That statistic has prompted health care advocates to introduce universal health care legislation every two years since the early 1990s. Current efforts focus on the Health Security Act, which has evolved and improved due to public feedback since it a version was first introduced in 1993.… Read More

Health Care Act – States’ Right to Innovate

Canada's universal health care program is much acclaimed and a product of state innovation. If Saskatchewan had not had the authority to devise its government-funded universal insurance scheme in the 1940s (a plan quickly copied by other provinces), Canada would most likely not have the single-payer plan that is so popular today.… Read More

Health Care Security Act – Connecticut

The Connecticut Health Care Security Act is a good single-payer model for other states to follow.

TheAct would have insured payment for all medically necessary services, medications, and long term care for all residents of the State of Connecticut. The bill sought to put decisions about health care in the hands of licensed health caregivers and their patients without insurer pre-approval.

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Single Payer Health Care – California

The California Health Insurance Reliability Act is based on a model released in January 2005 by the Lewin Group, an independent health care analysis firm. It would provide all state residents with full coverage of medical, dental, vision, and hospitalization services, and pharmaceutical benefits, through a statewide, single payer system.

The Lewin Group study was commissioned by California Health and Human Services, in accordance with a bill passed by the state legislature in 1999 that required a study of universal health coverage options. Nine proposals were studied – three single payer models and six proposals that increase coverage through public program expansions, employer incentives, or combination approaches.

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Universal Health Care Initiative – Massachusetts

A bill to create the Advisory Committee on Consolidated Health Care Financing was passed and funded in the summer of 2000. It was part of compromise legislation drawn up as a result of the statewide ballot initiative for a universal program. (For more about the ballot initiative, see Medical Student JAMA, October 1, 2003.) The committee's mandate was to analyze a financing system for health care "accessible to every resident of the commonwealth". A final report was published in December 2002.… Read More