Health care issues: A single-payer system?

A look at key issues in the health care debate:

THE ISSUE: Should there be a government-run, single-payer national health care system?

THE POLITICS: A government-run health care system is attractive to many Democrats, who want access to health insurance for all, including about 45 million uninsured Americans. One proposal in Congress would establish a program to provide all people in the United States with free health care through a publicly financed but privately delivered system. It would be paid for by raising taxes on the top 5 percent of income earners; instituting a progressive excise tax on payroll and self-employment income; and taxing stock and bond transactions, among other revenue sources. A doctors’ group, Physicians for a National Health Program, says streamlining payment through a single nonprofit payer would save more than $400 billion a year — enough to provide coverage for all Americans. Republicans oppose the single-payer approach, like those in Canada and many European countries, warning it would lead to a system where choice of care, treatments and a patient’s doctor would be mandated by Washington bureaucrats. They say quality care would be delayed and rationed, and a government takeover would curtail new treatments, drugs and innovation.

WHAT IT MEANS: While it has some support in Congress, the idea of a single-payer system doesn’t have much traction. President Barack Obama has distanced himself from the idea, saying it works well in some countries but wouldn’t be practical in the United States because so many people get private insurance through their employers. Yale University political science professor Jacob Hacker summed it up this way: “Threatening (employer) coverage is a political nonstarter, and moving all health care spending onto the public budget is virtually impossible in the current fiscal climate.”

— Jennifer C. Kerr