Single-Payer National Health Insurance

Single-payer national health insurance, also known as “Medicare for all,” is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

The program would be funded by combining our current, considerable sources of public funding (such as Medicare and Medicaid) with modest new taxes based on ability to pay. Over $500 billion in administrative savings would be realized by replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer.

Premiums would disappear, and 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.

The Medicare for All Act of 2019, H.R. 1384, based on PNHP’s AJPH-published Physicians’ Proposal, would establish an American single-payer health insurance system.

What about Obamacare?

The Affordable Care Act (“Obamacare”) aims to expand coverage to about 30 million Americans by requiring people to buy private insurance policies (partially subsidizing those policies by government payments to private insurers) and by expanding Medicaid. However:
  • About 30 million people will still be uninsured in 2023, and tens of millions will remain underinsured.
  • Insurers will continue to strip down policies, maintain restrictive networks, limit and deny care, and increase patients’ co-pays, deductibles and other out-of-pocket costs.
  • The law preserves our fragmented financing system, making it impossible to control costs.
  • The law continues the unfair financing of health care, whereby costs are disproportionately borne by middle- and lower-income Americans and those families facing acute or chronic illness.
Over the past two decades, peer-reviewed research by PNHP leaders framed the debate on health care and focused it on the need for fundamental reform. Our proposals detail what a single-payer system in the U.S. could look like.

Further information is available on our Single Payer Resources and FAQ pages, as well as in our FAQ handout.