Why Single Payer?

Frequently Asked Questions

• I like my employer sponsored plan. I don’t want to leave it.

  • Do you like your premiums, copays, coinsurance, and deductibles too?  No?  What is it exactly you like so much about your plan? 

  • You will get all the same services, see the same providers and more (no out of network restrictions), but will no longer have to pay out of pocket health care costs.

• How will you pay for it?

  • There are a number of different options, including a payroll tax, a graduated income tax, and a financial transaction tax. In every case, the taxes that individuals pay would be far less than the amount they pay now for deductibles, premiums, and copays.  

  • An estimated $400-500 billion is wasted in the US because of the profits taken by insurance companies and hospitals, as well as the huge amounts of time and money lost by doctors and hospital administrators on arguing and negotiating with insurers. There has been a 3300% rise in hospital administrators in the last few decades, largely because of the complexity of having many different insurance companies, and this is a huge driver of rising medical costs. Eliminating this will mean part of Single Payer pays for itself. 

  • Many government health programs, such as Medicaid and CHIP, still have eligibility requirements and waste huge amounts of resources on determining eligibility. Under single payer, this will go away—everyone will automatically be enrolled, eliminating the need for eligibility administration and saving enormous costs in money and time.

  • Many people avoid routine checkups because they don’t have insurance or their co-pays and deductibles are too high. When people delay care, small health issues often turn into bigger, more expensive problems. With a single-payer system, co-pays would be eliminated and preventive care would be encouraged. That means people could get help early, before issues become serious, reducing overall healthcare costs.

  • At the state level, in Michigan, the constitution will likely need to be changed through a ballot initiative or ¾ of the legislature. Right now, Michigan has a flat tax which is not progressive, and creates high income inequality. It also has a constitutional cap on how much money can be raised by the state, regardless of what is needed. These can and should be changed—and being able to provide universal healthcare is a perfect reason why. Efforts are starting now to do just that.

• Why not get government out of healthcare entirely, and let the free market bring prices down?

  • The free market may work for some things, but not others. Healthcare is one of those things. When people need medical help, they are often not in a position to comparison shop. Could you compare prices for emergency bypasses at different hospitals while having a heart attack? 

  • The free market is supposed to be more efficient, but of all the industrialized countries, we have by far the most free-market driven system. We also have by far the most expense, overhead, complexity, and the highest prices. This proves that the free market doesn’t work for everything.

  • Profits are made many ways, not just by lowering costs for customers. They are also made by denying service; this is how insurance companies have done it for decades.

• I’m all for universal healthcare, but isn't this just a pipe dream?

  • The 60s activist Tom Hayden once said “change is slow, until it is fast.” Many of the most important advances for justice seemed to most to be impossible until they suddenly happened. People said there was no way to get rid of slavery, there was no way women would ever get the vote, there was no way civil rights would get passed, and there was no way the Berlin Wall would ever fall, until the hour before it fell. 
  • Cynicism is part of a strategy for preventing change. We are taught to be so cynical about the corruption of our political process that we disengage from it, which is the very thing that allows our politics to be corrupted. It’s a vicious circle! You can break that circle by rejecting cynicism.  Fighting for single payer is a fight for politics that we can believe in again. 
  • 85% of Democrats are in favor of universal single payer healthcare, and 60% of the overall population. At some point, the mass of voters will outweigh the corporate interests.
  • 45% of Republican voters support a national healthcare system

• Doesn't this really have to be a national program? How could this work at the state level? 

  The proposed federal legislation called State Based Universal Health Care Acts (SBUHCA) would give states the ability to request waivers from the Federal government to pay for state based universal health care. In Michigan, we have the proposed MICare bill that will get us started on the path.
  These waivers allow States to redirect federal money coming into the state which pay for health care and place them into a fund to pay for a state based universal health care system. The redirected Federal money funding Medicare, Medicaid, Children’s Health Insurance Program (CHIP), Federal Employee Health Benefits Program (FEHBP), other federal programs and subsidies and state funding sources would flow into one fund to pay to health care needs.

  To waive requirements for a federal program, the state plan must have benefits equal to or greater than those that the beneficiaries of the federal healthcare program would otherwise receive. A group of states can also submit a joint plan. This bill was introduced in late 2023 by U.S. Representative Ro Khanna (CA-17) as H.R. 6270. Section 1332 of the Affordable Care Act (ACA) allows states to innovate, but it does not go far enough.

  SBUHCA amends the ACA with a 1335 super-waiver, which provides additional federal support for states to develop their own universal healthcare plans. Section 1335 makes it easier for states to model systems and build toward a national healthcare plan.

  What SBUHCA does:
  Allows states to get federal waivers for a universal, simple, and affordable (USA) plan.

  • Mandates that participating states guarantee healthcare coverage for at least 95% of residents in the first 5 years
  • Requires any state-based plan to have benefits equal to or greater than those that the beneficiaries of federal healthcare programs now receive.
  • Allows groups of states to come together for joint plans. Section 1332 of the Affordable Care Act (ACA) does not.
  • Enables states to integrate Medicare funds into a state plan. Section 1332 does not.
  • Gives access to an ERISA waiver to reduce legal challenges to a state plan. Section 1332 does not. This gives states more legal certainty in legislative efforts.
  • Creates an HHS Secretary-appointed Independent Assessment Panel, composed of members recommended by political leaders of both parties, health care provider groups, and a patient advocate [see Section 2 (g) (4) of H.R. 6270]. This panel will review and provide the state and the Secretary recommendations regarding waiver approval or disapproval. By contrast, Section
    1332 leaves the review process up to the HHS Secretary.
  • Paves the way to nationally guaranteed universal, simple, affordable (USA), and equitable health care.

  * We are already paying for health care, it is just coming through our premiums and co-pays. Single payer eliminates these, and money instead goes to the state program. Single payer does not require more money for healthcare—it just changes the path that healthcare money takes.

• What about all the workers in the insurance industry (and some in the medical industry) who will lose their jobs?

  • The House and Senate Bills contain funds for five years of salary and benefit replacement for workers (not insurance executives). We waste so much money on insurance companies that we can do this and still save $100s of billions a year!

  • Truth be told, most of the Democrats and Republican politicians who raise this issue are using it as a smokescreen excuse. Industries change all the time. Who raised an objection with Amazon.com put most of America’s bookstores (and now toy stores and other retailers) out of business? Or when the Uber put 10,000s of cab drivers out of work?  Many of the same politicians who raise this objection are either silent about or in active support of many other policies that will put workers out of work—like driverless technology.  At least single payer legislation contains provisions to help displaced workers—more than most corporate politicians do.

  • At the state level, the current plan for the Michigan bill is to provide preferential hiring for displaced workers in the new single payer system.

• Why should a hardworking person like me pay for some lazy person’s healthcare?

  You’re already paying for other people’s healthcare. As a taxpayer, you already pay for nearly half of all Americans, through Medicare, Medicaid, CHIP, the VA, and emergency rooms.  It breaks down as follows:

  • Medicaid and CHIP have 75 million Americans

  • Medicare has 55 million Americans

  • The VA has 10 million Americans

  • Emergency rooms lose $50 billion a year on treating those who cannot pay—taxpayers pick up most of this tab.

  Furthermore, you already pay for other people’s roads, schools, defense, clean water, clean air, safe food, etc. This is no different, and just as important.

  Those who receive this care are in fact deserving. All humans deserve healthcare no matter what. But to break it down more clearly:

  • Those on Medicare paid into the system their whole lives; at some point you too will receive Medicare and others will be paying for your healthcare then. 

  • Those in the VA system served our country and often were in combat and have combat related health needs. 

  • Those in CHIP are children, and are too young to work. 

  • And many who receive Medicaid are disabled children, or elderly in nursing homes. Of those who are able bodied and of working age (about 24 million), 60% work, and 80% live in a household where one adult works—usually someone staying at home to care for children or others.

  • There are only about 4.8 million Americans who receive Medicaid who do not work and are not part of a household that works; and even these often have circumstances that are not easily definable. $638 million is spent on this population’s healthcare, which is 0.015% of the total federal budget (which is $4.2 trillion). This means an employee who makes $50,000 and is single in Michigan pays around $2 in taxes a year for those on Medicaid who “don’t work.” 

• Why do people say that healthcare is a right? 

  • The US Constitution says that one of the main purposes of its existence is to “promote the general welfare” of the people (in the Preamble). Courts have affirmed that this includes the physical health of the people. The Constitution also affirms the power of Congress to raise taxes for this purpose in Article I, Section 8, Clause I, which has been upheld for centuries in the supreme court.

  • The Declaration of Independence says we have an unalienable right to life, liberty, and the pursuit of happiness. 45,000 people a year die because of lack of health coverage. Aren’t their rights violated?

  • Most religious traditions agree that it is a right; Jesus himself spent much of his ministry healing the sick. The Pope recently affirmed that health is not a consumer good but a universal right, and the council of American bishops have agreed.

  • By all international standards, including the UN Declaration on Human Rights, healthcare is a basic human right. 

• Won’t people just overload the system, over-use the healthcare system making it unsustainable, if you make it “free”?

  • Do you love going to the doctor or the hospital? Do you love tests and operations? How many people do you know who do? The vast majority of people don’t “want” to use healthcare, they only do so when they need to.

  • All the data proves this. It doesn’t happen in any of the other countries that have universal health care—people in England, Canada, Australia etc. do not use health care dramatically more than Americans, they just use it more efficiently, for preventive care rather than catastrophic care 

• I don’t want to see a government doctor / can I continue to see my own doctor?

  • Not only will you be able to continue seeing your doctor, you will be able to go to any doctor or hospital you want, with no hidden costs or gaps in coverage.

  • Single payer is simply shifting how we fund healthcare providers, not replacing the providers. Hospitals and doctors will continue to work as they had before, only they will receive funding from the single payer system, rather than having to deal with the hassle of getting money from many different insurance companies, or not getting paid at all. There are no “government doctors,” with the exception of the VA.

  • In reality, a lot of doctors are already in part “government doctors” since so many of them already get their payment from Medicare, Medicaid, CHIP and VA.

• The government screws up everything it touches, why would we want it running our health care?  Look at the VA!

  • The VA is actually very popular—93% of veterans said they were highly satisfied with the treatment they got through the VA in a recent study. The VA has better health outcomes than the private sector as well. The negative news about the VA was about one particular instance.
  • Do you trust your insurance company more? Only 7% of Americans surveyed said they have a favorable view of health insurance companies. They care about making money, not your health, and unlike the government, if you don’t like them you have no democratic means to change what they do.
  • The Department of Justice (DOJ) has filed class action law suites against: United Health for $100s of millions for denials, misleading investors, Medicare Advantage over charging; BC/BS for violation of antitrust laws amounting to over $2.8 Billion of pay backs to hospitals and professional healthcare providers; the DOJ just completed a “NATIONAL HEALTH CARE FRAUD TAKEDOWN” resulting in over $14.6 Billion of alleged fraud committed by for profit healthcare providers. 
  • Does the government screw up the military? The fire department? The postal service?  National parks? NASA? What specifically negative experiences have you had with the government? The assumption that government is always a problem is a narrative constructed by people who want to eliminate important government services which do not bear up in reality, nor in most people’s own experiences.  Every organization is prone to making mistakes—Equifax just let themselves get hacked and got almost half of America’s credit info stolen. Again, at least government is accountable to the people; private companies are not.

• What about rationed health care, waiting lines, or death panels?  Like in Canada?

  • We often have long wait times now. Have you ever been to the ER, especially on a weekend? That’s because of all the uninsured people who use the ER as their primary healthcare. Have you ever had to wait months to get in to see a specialist, even if you had a serious health condition? This is often made worse by the fact that most insurance plans limit your choice to in-network, so if the only in-network providers near you are booked, you are out of luck. In single payer you can call far more providers to find one with an opening.

  • The US ranks in the middle of the 19 wealthiest countries in the world for waiting times.  Shorter than Canada, but longer than other modern countries with universal healthcare—Germany, France, England, Australia, New Zealand and others have much shorter wait times that we do. All of these countries prioritize life-threatening situations. In Canada, the higher wait times is for elective procedures; wait times for urgent procedures is also shorter than in the US. 

  • We already have rationing—even of Americans who have health insurance, most of them have very high copays and co-insurance, and high deductibles, so they have to be very careful about when they see the doctor.  The expenses they do incur—an average family spends around $20,000 a year on health care—means they have to cut back on other expenses.  We ration healthcare so that those with a lot of wealth get to live; those without a lot of money do not.

  • There are already death panels, they are the lawyers who work for the insurance companies and do nothing but find ways to avoid authorizing or paying for services, or incentivizing hospitals for not performing certain expensive yet life-saving operations. 

• Doctors don’t take Medicaid/Medicare now because of low reimbursements, won’t they go out of business or leave the state?

  • Actually, 93% of doctors take Medicare, almost exactly as many as take private insurance.  A lower number, 70%, take Medicaid, but that is still a large number.

  • Single payer will hold to Medicare, not Medicaid, reimbursement rates. There is no reason to believe that less than 93% would continue to participate with single payer.

  • Doctors who don’t take Medicare generally are “boutique” or “luxury” doctors, who cater to the extremely rich. This will continue under single payer.

  • Doctors who aren’t “boutique” doctors will not have much choice, as most health insurance companies will no longer have much role to play.

• What if I want to opt out of it?

  • You don’t have to use it, you can pay out of pocket for your healthcare if you want. 

  • It’s no different than Medicare, when you turn 65, you don’t have to use it. 

• If we give Medicare to everyone, it’ll be worse for seniors—less to go around for them.

  • It will be better for those on Medicare—the current proposals expand Medicare, which currently only covers about 80% of costs.  Under the Medicare For All Acts, the State Based Universal Health Care Acts and Michigan’s MiCare legislation seniors on Medicare would see their co-pays and premiums eliminated.
  • All of these pieces of legislation will promote expansion of hospitals and healthcare clinics into communities who are currently under served. Healthcare will be based on the healthcare needs of the communities rather than profits. This will provide more accessible locations to satisfy our healthcare needs than is currently available.

• What will happen to people already on Medicare, Medicaid, the VA?

  • In the national “Improved Medicare for all” plan, the VA and Medicaid would be folded into the program, those on Medicare would see no change except that their coverage would become comprehensive.

  • In a state plan, those on Medicaid would be folded into the plan; those on Medicare would use the state plan as their Medigap coverage, so they would no longer pay premiums or copays; likewise, those in the VA would use the state plan to cover what the VA didn’t cover.

• Would I still need to go on the exchanges?  Pay the penalty?  What will happen to Obamacare?

  • In a national Medicare for all scenario, many aspects of Obamacare would go away, including the exchanges, the individual mandate, and the employer mandate.

  • In a state single payer plan, the state would seek to get rid of the exchanges with permission from the federal government. All state residents would be protected from the penalty, since their state plan would satisfy the requirements of health insurance.  

• We pay more for healthcare in this country because we do all the R&D; all the breakthrough medicines and procedures and devices are invented here, the rest of the world just benefits from it.

  • Most of the R&D is actually done by academic and government institutions, like Universities and NIH, not big pharma, health equipment companies, etc. 

  • The US used to lead the world in medical R & D, but no longer. Right now China does about as much as us, and Asia total does much more–the European Union is not far behind the US and Asia. This is a trend that is going to continue according to all analysts. All the countries in Asia and in Europe use single payer or universal healthcare. It is the size of the economy and the strength of the academic institutions that impact R &D, not whether there is a free market or not. 

• Will it fund abortion?

  Yes

• If people don’t have to work to get healthcare benefits, they won’t get jobs.

  • Studies show that this is not the case; most people who are on Medicaid also work, and those who become eligible for Medicaid do not usually quit their jobs.

  • In fact, many will be incentivized to get the job they want, or start the business they wanted to, because they are held back by “job lock.” Those who turn 65 and receive government healthcare through Medicare show an increase in entrepreneurial activity.

• I’ve been on Medicaid / Medicare, and it is a nightmare fighting with them over eligibility and enrollment. 

  • Single payer is automatic enrollment.  There will be no eligibility requirements, applications, or denials.  You are automatically enrolled at birth or upon achieving residency. 

• Isn’t fee-for-service the problem?  How does Single Payer fix fee-for-service?

  • Fee-for-service is a tricky problem.  Right now many doctors spend too little time on average with patients—about 15 minutes per patient. This is because they get paid per office visit (“fee-for-service”), so they have an incentive to get as many patients in and out per day as possible.   

  • Single payer could help this problem because it will set up a regulatory board that can perform audits on whether doctors are seeing too many patients in a defined period of time.