Observations Atlantic crossing

Why single-payer health systems spark endless debate

BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39196.414595.59 (Published 26 April 2007) Cite this as: BMJ 2007;334:881
  1. Uwe E Reinhardt, James Madison professor of political economy, Princeton University, Princeton, NJ, United States
  1. reinhard{at}princeton.edu

    Are they a panacea or a form of “socialised medicine”? Americans just cannot agree

    Whenever Americans lapse into their periodic “conversations” on health reform, a single-payer health system is proposed by some as the panacea and condemned by others as “socialised medicine.” Rarely are the pros and cons of single-payer systems fairly debated.

    In single-payer health systems, the entire population shares one health insurance carrier, usually the central or provincial government. Such systems should not be confused with “socialised medicine,” in which the government also owns and operates the healthcare delivery system. Single-payer health systems typically are just social insurance grafted onto pluralistic delivery systems, which may include investor owned, for-profit enterprises. Canada's and Taiwan's health systems are classic examples of this genre, as is the government run Medicare system for elderly people in the United States for the services it covers.

    To their proponents, single-payer health systems offer several distinct advantages over pluralistic health insurance systems, such the American system.

    Firstly, single-payer systems are the ideal vehicle for implementing an egalitarian social ethic, if that is what the citizenry desires. …

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