Stop Misleading People with the Wrong Terms – More Thoughts on Single Payer

This article was originally posted on LinkedIn and was featured on LinkedIn Pulse.

I recently got the following question from my friend Tom DiLiegro on LinkedIn:

“To me, there seem to be several definitions of single payer. How do the various factions define their versions?

As I discussed in this article I wrote back in June, there is a lot of confusion around the terms being used in the current health care debate, and it’s critical to understand the differences. Single-payer, universal healthcare and Medicare-for-All are not synonymous, although they are often used that way by supporters, politicians and the media. Here’s a breakdown:

  • “Universal health care” is a more broad term for a program that makes some level of basic coverage available to everyone (usually through a government program), but also allows for private insurance coverage. Most countries with socialized health care have some version of a universal health care plan.
  • A “single-payer” plan creates a single source of payment to providers, typically through a state or federal program. This is the type of plan proposed in the Healthy California Act, SB562, which is currently making its way through the California state legislature.
  • “Medicare-for-All” is a specific type of universal health care plan in which the federal Medicare program would be replaced (see more on this below) and would provide a basic level of care for all. By referencing Medicare, which is an existing program, the author of the bill implies that participants would be allowed to purchase private insurance, as they can now, to supplement the basic plan. But Bernie Sanders’ “Medicare-for-All” plan proposes the elimination of private insurance, so his plan looks much more like a true single-payer plan.

I’ve read from many sources that Sanders chose the term “Medicare-for-All” because it polls better than other terms, and there is a high affinity for the Medicare program, especially for those who are covered by it (and the supplemental coverage that one in four Medicare participants choose to purchase). I think it’s misleading to re-purpose the Medicare “brand” and imply that this would be an expansion of the current program, when in fact it would be a total retooling and replacement.

Similar to the Healthy California Act, “Medicare-for-All” plan is more of statement of intention than an actual bill that has any chance of passing. The plan is more generous than any other country’s universal health care plan, yet it has no funding mechanism. While many U.S. Senators are signing on as supporters of the bill to establish their positions as 2020 Presidential hopefuls, there is little likelihood that this plan (in its current form) will become a reality.