The Single Payer Healthcare System (labelled “Medicare for all” by Bernie Sanders) has garnered a lot of attention in recent years, especially within California. The most recent of many attempts to implement this proposal – which would have made California the only state in the country to have a single payer healthcare system – was Assembly Bill 1400, but it was dismissed during a state assembly session on January 31, 2022. This bill advocated for the creation of CalCare – a public system that would have provided all Californians with appropriate access to medical care. This single payer system is already implemented in many countries around the world, but nowhere in the US. Given that this system will undoubtedly be debated by government officials for the next few years, it is worth diving into some of the largest positive and negative changes this system would bring to the lives of Californians.
The most obvious benefit of this system is that it would provide healthcare for everyone. A recent poll showed that 8% of the United States lacks access to healthcare, while many other countries have completely eliminated this percentage with universal healthcare. A big reason for this is the financial burden that comes with complete medical coverage. Unfortunately, most uninsured people in California are willing to pass up on receiving medical care in order to save money. But this can cause medical conditions to worsen over time, until eventually, they end up in the emergency room. If everyone was provided with proper medical coverage, the overall health of Californians would be better because preventative measures would be much more effective. Doctors could identify key health issues within their communities, such as high blood pressure and high blood glucose levels, before they progress to cardiovascular disease and diabetes. Catching these issues earlier would reduce the financial strain on California’s healthcare system, since it is much easier to help individuals before they develop life-threatening conditions than after.
Moreover, this system could incentivize businesses to pay their employees more fairly. One reason that employees sometimes don’t get paid enough is because companies with greater than fifty employees are required to pay for their workers’ medical coverage as mandated by the Affordable Care Act; this can be financially draining, especially for smaller businesses. However, a single payer system would guarantee that all individuals are covered under a public government plan, making it easier for companies to pay their employees at a reasonable rate. People would be also be less tied to a single company, since moving from company to company wouldn’t mean uprooting their medical coverage. This freedom of movement would heighten competition to hire and retain workers and may further raise wages.
At face value, the single payer healthcare plan really does sound like an ideal solution. Who wouldn’t want everyone in California to have access to appropriate healthcare? But why then does California postpone or sideline this bill time and time again? Sure, we could blame it on government corruption since “Medicare for all” would be devastating for private insurance companies. But aside from this, there actually are many reasons to stay away from such a healthcare system. Firstly, providing coverage for all Californians would require a massive amount of funding, and the only way to make this feasible would be to significantly increase taxes. The increase would be so large that it would cause many families (especially those that earn less than $200,000 a year) and businesses to struggle. To avoid businesses shutting down and a high probability of a rising unemployment rate, we may have to explore other options to assist individuals that lack proper healthcare.
The government could help fund the policy by diverting funds from other areas such as education, scientific research and infrastructure, but this would not be ideal either.
Another negative consequence of this plan would be that the time taken to get appropriate medical care may greatly increase. While there are mixed opinions and inconsistent data about this, one comprehensive 2017 study showed that the average wait time for a patient to get referred to a specialist from a general practitioner was 21.2 weeks among Canadian provinces which have universal healthcare, significantly more than most other countries. These delays could increase the number of deaths, since certain surgical procedures are time-sensitive and lose their effectiveness as a given medical condition worsens. It is common practice for patients with significant medical problems to be referred from one physician to another (such as from an internal medicine physician to a neurologist or cardiologist), but what would happen if this process became inefficient? In addition to patients being inconvenienced and doctors being overworked, this could allow diseases within a population to progress if it takes longer to address them – despite this being an issue that universal healthcare supposedly solves.
While it is easy to paint a picture of private insurance companies filled with ruthless and greedy businessmen, we shouldn’t be so quick to dismiss the benefits that have arisen from the industry. The central benefit of private coverage is the large number of medical innovations that have stemmed from ambitious medical providers. With a single payer healthcare system, we could potentially hinder competition since everything would be nationalized. Without the allure of profit, there may be a reduced incentive to produce medical technologies that are faster, cheaper, and more effective – all of which we desperately need. This issue could be addressed if the government takes a larger role in providing significant funds for innovative products, thus reestablishing the necessary incentive. However, the government would also need to continue funding research universities as well as research agencies such as the National Institute of Health, and this would require more efficient government spending. The only thing we can say about the Single Payer Health System plan is that there is no right answer. There will never be a perfect solution when it comes to healthcare. The important thing is that we take the time to really understand how this plan would affect our lives – both now and in the future.