Many Americans are in Single-Payer Systems Already

A Little Under Half of the Insured in the U.S. are Covered Under Single Payer Systems: Are Our Single Payer Health Care Systems Working?

About 35% of the insured in the U.S. are covered under single payer systems. The VA System, Medicare, and Medicaid/CHIP are single payer systems. Meanwhile about 7% get coverage via the private market and about half get coverage through their employer. SEE: Health Insurance Coverage of the Total Population for specific numbers.[1]

In other words, less than 10% of all individuals in the U.S. actually buy their own insurance from the private market directly, and almost all Americans either use a type of single payer system or cost-share with their employer.

Below we look at our existing single payer health care systems, the VA System, Medicare, and Medicaid, and ask how well they are working for us. After-all, with all the claims floating around that single payer doesn’t or does work, it seems silly to ignore the single payer systems that cover a good portion of our population already (never mind the universal healthcare systems every other major country on earth has).

The VA serves almost 9 million people.[2] Medicare and Medicaid cover over 100 million people.[3] In fact, more people in this country are served by single payer systems than by private or employment-based plans.

What is happening in the VA System?

The Department of Veterans Affairs has experienced a huge demand for services especially since more military personnel are surviving wounds that used to be fatal and are living with significant disabilities. The Veterans Choice and Accountability Act of 2014 was enacted in an attempt to hire more personnel, cut wait times, and give veterans more treatment options. According to N.P.R., VA Hospitals Still Struggle With Adding Staff Despite Billions from Choice Act.[4]

The VA is undergoing reorganization as David Shulkin, Trump’s Secretary, attempts to address its troublesome issues. When dealing with questionable staffing; he fired, demoted, or suspended 747 people as of July 3, 2017. Under him, the VA has improved the crisis line and other mental health services and developed improved prosthetic limbs. The agency is exploring the better use of their resources. Conditions for those in the VA system seem to be improving.[5]

The VA has employees instead of doctors who are in the open market and accept fees for services although there is some out-sourcing of care. The VA has had to raise the pay of medical practitioners to meet market demands.[6]

What is happening in the Medicare and Medicaid System?

All health care organizations that participate in Medicare and Medicaid must meet specific Conditions of Coverage 9CfCs) and Conditions of Participation (CoPs).[7] Medicare is regulated and provided to elderly and disabled individuals; Medicaid is provided to low-income and disabled individuals; Children’s Health Services Program (CHIP) provides care for lower-income children.

These programs together help make sure that as few children, elderly, disabled, and low-income people are left without the care they need as possible. However, the care people get is not always good-quality care. There is both over-treatment by providers intent on billing as much as possible and under-treatment if there is not much money to be made.

Medicare’s fee for service model is designed for speed, not selectivity, and fraud is common. Moving toward an integrated delivery system like the VA’s model may help increase efficiency. For a discussion of this issue, see Joseph Minark’s article, What’s Right, What’s Wrong With Medicare.[8]


Although constant improvements are being made to our single payer systems, we find the same types of complaints repeatedly. There is a shortage of medical practitioners willing to work in single payer systems. There is also a concern that treatment provided may be based on potential profit rather than medical need.

The salaries and fees in single-payer systems have caused many consumers to face long wait times and a shortage of specialists. Poor reimbursement schedules in single payer plans combined with restrictive drug formularies have resulted in both patient dissatisfaction and many professionals’ reluctance to practice in single payer systems.

Take a look at a website that discusses the earning potential in medical fields like The Student Doctor Network.[9] The rewards of working in a single payer system at present are more of an ethical and personal choice than a monetary one.

The economics of our medical health care presents an ongoing concern.

Article Citations
  1. Health Insurance Coverage of the Total Population
  2. Department of Veterans Affairs Statistics at a Glance
  3. The Medicare Blog
  4. VA Hospitals Still Struggle With Adding Staff Despite Billions from Choice Act
  5. Trump’s VA Secretary off to a Fast Start
  6. VA Hikes Top Pay for Doctors
  7. Conditions of Coverage 9CfCs) and Conditions of Participation (CoPs)
  8. What’s Right, What’s Wrong With Medicare
  9. The Student Doctor Network

Author: Linda DeSolla Price

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Proponents of single-payer health care point out that the Mercatus report suggests that national health expenditures could decline by about $2 trillion over the same 10-year period. National health expenditures refers to all health spending, including that of the federal government, private employees and state Medicaid programs, while federal health expenditures refers only to spending from the federal government.

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