Medicare for All and Universal Health Care

Medicare is a single-payer system but is it enough?

Medicare for All universal healthcare
 Jasmin Merdan / Moment / Getty Images

Anyone who believes the American healthcare system is the best in the world is in for a surprise. The truth is the United States spends the most on health care per capita but has the poorest health outcomes.

An analysis by The Commonwealth Fund specifically looked at 11 developed nations. Data was gathered across five categories: 1) care process (preventive care, safe care, coordinated care, and patient engagement), 2) administrative efficiency, 3) access (affordability and timeliness), 4) equity for people across low- and high-incomes, and 5) healthcare outcomes (population health, mortality amenable to healthcare, and disease-specific health outcomes). Sad to say, the U.S. ranked 10th for administrative efficiency and 11th for access, equity, and healthcare outcomes.

The countries that ranked above the United States on the list had one thing in common — universal health care. The question is whether or not the United States should follow in those footsteps.

Medicare as a Single-Payer System

During the 2016 presidential campaign, former Secretary of State Hillary Clinton stated that Medicare was a single-payer system. What does that mean?

A single-payer system is one where one entity, usually a government, manages and pays for your healthcare. "Single payer" is often interchanged with the phrase "universal health care" in lay terms, though they are not exactly one and the same.

In America, Medicare has been the healthcare system we look to as we grow older. It is a single-payer system because the government funds the health program via the taxes we pay into it. That said, it is not universal health care because it does not cover everyone. Instead, it is limited to people 65 years and older or to those with certain disabilities.

Tricker perhaps is that while Medicare started out as a true single-payer system, it has evolved into something more capitalistic. The federal government sets the standards for what must be covered but people may choose to sign up for a Medicare Advantage plan, run by private insurance companies, as opposed to traditional Medicare, run by the government.

Medicare for All vs. Medicare for More

Medicare could be expanded and made available to all Americans. In that way, Medicare could become universal health care. Such a plan was endorsed by Senator Bernie Sanders of Vermont and came to be known as Medicare for All.

During her bid for the 2016 presidency, former Secretary of State Hillary Clinton suggested "Medicare for More" as a way to expand Medicare. Instead of Medicare for All, she proposed decreasing the Medicare eligibility age from 65 to 50 years old.

How would this help?

People in this age group tend to have a number of medical conditions and more medical conditions mean more healthcare spending. At least 87 percent of Americans aged 65 to 74 years old have at least one chronic medical problem. The number increases to 92 percent for those 75 years and older. The numbers decrease to 72 percent when we look at the younger 50 to 64-year-old population, not currently covered by Medicare.

Once someone meets eligibility criteria for Medicare, they begin to pay monthly premiums for medical coverage. This money is put into a pool and used to pay for services for all beneficiaries. If younger, relatively healthier Americans were added to that pool, then an interesting thing would happen to Medicare as we know it today. There would be more money to share. Though there would be more people in the pool, there would be a smaller average number of medical conditions to address. This could potentially add years of savings to the Medicare Trust Fund.

Pros of Universal Health Care

The truth is that healthcare costs have increased sharply over the years, not because of inflation or the costly medical technology but because of big business and capitalism.

As long as private insurance companies and pharmaceutical companies hold the purse strings, healthcare costs will continue to rise. As it stands now, not everyone is offered the same services. Medicare Advantage plans are able to offer more benefits than Original Medicare but few people are offered everything they need. A single-payer system would remove the profit-driven motivations for health care but what else does it offer?

Everyone would have equal access to care regardless of age, income, or ability. Also, you would no longer have to find a doctor in your "network" because all doctors would be in your network. Copays and deductibles would go away.

A national survey from the Pew Research Center in 2017 noted that 66 percent of Americans believe the government should ensure access to health care and that 33 percent feel that a single-payer system is the best way to go.

Cons of Universal Health Care

Dollars and cents are not the only cost of universal health care. Americans would not only need to consider the likely increase in taxes they would pay but also how universal coverage would shape the care they receive. Wait times for non-emergent services would get longer. With more people in the system, access to their doctor of choice could be affected by longer wait times. Some people may have to change doctors to access non-emergent care in a timely manner.

Wait times in countries with universal health care can be long. In Denmark, the mean time to get cataract surgery after the decision is made to treat is 112 days. You may not be able to get a hip replacement in England for 78 days. Elective surgeries in Ireland or Norway will leave you waiting 75 days. That said, urgent cases are acted on urgently. There is no delay in care when you truly need it. 

In the long-run, the United States could save in overall costs and improve healthcare outcomes under a universal system, but do Americans have the patience to wait their turn?

A Word from Verywell

The U.S. healthcare system has a choice to make. It can improve upon its single-payer model of Medicare, extending its reach to more Americans. Alternatively, it can follow the path to universal health care that many developed nations have shown to be more cost-effective and efficient with better health outcomes. Being eleventh best in healthcare worldwide is not good enough. America deserves better.

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