Understanding the Single-Payer Healthcare System

A single-payer national health insurance, often referred to as “Medicare for all,” represents a healthcare financing approach where a single public or quasi-public entity manages the collection of funds used to pay for medical services. Importantly, while this centralized organization handles the financial aspects, the actual delivery of care remains predominantly in private hands. Under such a system, every resident of the United States would have access to comprehensive, medically necessary services, including visits to doctors, hospital stays, preventive care, long-term support, mental health services, reproductive health, dental, vision care, prescription medications, and necessary medical supplies.

Funding for this program would be achieved by consolidating current public funding sources—such as Medicare and Medicaid—and supplementing them with modest new taxes scaled to individuals’ ability to pay. Transitioning to a single-payer system could lead to significant administrative cost savings, estimated at over $500 billion, by replacing the existing complex, profit-driven insurance landscape with a streamlined, nonprofit public payer. This overhaul would eliminate premiums, and approximately 95 percent of households would see reduced expenses. Patients would no longer encounter financial obstacles like co-pays or deductibles and would be free to choose their preferred healthcare providers without restrictions. Additionally, physicians would regain greater autonomy in making clinical decisions without interference from insurance companies.

The legislative blueprint for establishing such a system is embodied in the Medicare for All Act of 2021, H.R. 1976. This legislation draws upon proposals published by the Physicians for a National Health Program (PNHP) in reputable journals, aiming to create a universal, comprehensive health insurance framework for the United States.

What about Obamacare?

The Affordable Care Act, known colloquially as “Obamacare,” seeks to extend health coverage to approximately 30 million Americans by mandating the purchase of private insurance plans, often with government subsidies, and by expanding Medicaid. Despite these efforts, several persistent issues remain:

• An estimated 30 million individuals will still be uninsured in 2023, with many more underinsured.
• Insurance providers continue to limit coverage by reducing policy benefits, maintaining restrictive networks, denying or delaying care, and increasing out-of-pocket expenses such as co-pays and deductibles.
• The law maintains the current fragmented system of healthcare financing, making effective cost control difficult.
• The existing financing structure disproportionately burdens middle- and lower-income families, especially those facing ongoing or severe health conditions.

For a detailed comparison between the single-payer approach and the current system, consult this informative chart.

Ready to take action?

Encouraging your congressional representatives to support a single-payer system can bring about meaningful change. You can easily send an editable letter of support through our platform. For additional ways to advocate for healthcare reform, visit our Take Action page.

More questions?

Over the past twenty years, peer-reviewed research conducted by PNHP leaders has shaped the debate around healthcare reform, emphasizing the need for a fundamental overhaul. Their proposals outline what a functioning single-payer system could look like in the United States.

Further details and resources are available on our Single Payer Resources and FAQ pages, along with our comprehensive FAQ handout. Gain a deeper understanding of this vital issue to inform your advocacy efforts.

Información en Español

> About the national health coverage proposal with a single payer system