The Single Payer Healthcare System

Ian McIntosh


The single payer healthcare system has been proposed as a possible solution for America’s healthcare woes. Some experts believe, however that the system could put the nation into deeper debt. This article examines the single payer healthcare system from both sides and takes a look at how the system is performing in Canada.


The single payer healthcare system has become a hot topic in today’s healthcare reform environment. Several other countries have utilized the single payer healthcare system and many experts argue that it could be the answer to America’s healthcare problems. In contrast, other experts argue that a single payer healthcare system could put the nation into an even deeper financial hole. The primary argument from proponents is that a single payer system could possibly help move the economy in the right direction by having costs go directly to the government instead of having insurance through several different providers (“Single Payer System is Healthcare Stimulus,” 2009). This system sounds positive when looked at on paper. Advocates for the single payer system argue that the issue should be making care accessible instead of how many providers are in the market (Gusmano, Weisz, & Rodwin, 2009). A single payer system is becoming more likely today, but it could make things even worse for America’s already volatile healthcare system.

Pros and Cons

Many experts argue that a single payer healthcare system is the solution to establishing healthcare reform in the midst of an economic crisis as it offers the most care at the least cost. This makes a single payer system extremely popular due to the economic recession the nation is facing. A single payer system would allow more individuals to be covered as costs would be controlled more effectively due to the fact there is only one provider instead of several (Glied, 2009). However, with these benefits also come negatives. A main issue that has been reported concerning the single payer system is excessive rationing of care. When healthcare practices ration their care, it usually results in longer waiting times which means individuals may not get the care they need in the time they need it (Oliver, 2009). The single payer system allows resources to be sent to a place where their use may be the most valuable. Essentially, needs are cared for before wants. Also, two people may need the same exact care, but one of them may not get the care he needs because the single payer system decided someone else needed it more. As a result, he will have to wait to get the care he desires (Flood, 2009). It may not be a legal issue, but it is definitely an ethical issue that must be taken into consideration when implementing a single payer system. The question is whether it is worth having everyone covered if they have to wait an enormously long time for the care they need.

Another problem the single payer system poses is that it leads to fewer choices when it comes to care. When a single payer system is in play there is only one source of care. The logical result is fewer doctors and fewer practices in the medical field. Choice of provider is a unique feature of private health insurance, unlike a public single payer system which virtually eliminates choice when it comes to treatment (Oliver, 2009). Choice is what has made the United States healthcare system not only unique, but the best in the world. A single payer healthcare system would effectively destroy that. When individuals have more than one choice it usually means competition—which is a good thing because competition means the providers have to improve their quality to stay profitable. Since a single payer system virtually eliminates choice it would also eventually eliminate jobs. The economy cannot handle any more job losses, especially ones that are government inflicted. A healthcare system that rations its healthcare and eliminates choice sounds more socialistic than democratic. The single payer system at best is unethical.

Single Payer Healthcare in Canada

As the single payer system is beginning to become more popular, or at least plausible, experts are examining other countries that have single payer systems to see how the system would translate in America. The most popular example is Canada. It has long been argued that Canada’s single payer healthcare system provides its citizens with better care and lower costs than the United States healthcare system. Pundits also argue that Canada’s single payer system distributes resources more effectively and evenly than America. However, empirical data disagrees with these claims. For instance, individuals in America diagnosed with various types of cancer have a better five year survival rate than those in Canada. Also, low birth weight babies have a better survival rate in the United States than they do in Canada. These great success rates in America cover a multitude of different healthcare situations (O’Neill & O’Neill, 2007).

Canada’s government, the main provider in healthcare, controls every single aspect of healthcare. The government controls the budgets for each hospital in the country and expects the hospitals not to exceed the budget they are assigned. As a result, hospitals in Canada usually have to perform a lot with a little. Budgets generally stay the same or near the same each year, which means there is little money to purchase new equipment or invest in innovative new methods and technologies. This leads to another major problem in Canadian healthcare which is very long waiting times. When finances are tight, wait times for care increase. This creates an ethical issue because the hospital is trying to wait as long as possible to treat someone due to financial concerns even if the individual needs, or wants, care sooner. In short, the single payer system leads to rationing of healthcare.

Another problem is that prescriptions in Canada are paid for out of pocket. Therefore, the government attempts to keep drug prices low through subsidies. However, despite the government’s attempt to keep costs low, Canadians must still pay for their prescriptions strictly out of pocket. This would cause problems in America where almost 250 million Americans have some type of assistance with the cost of their medications. In addition, physicians’ pay is much less in Canada than it is in the United States. Canada plans to keep costs very low by managing and cutting costs wherever possible (Halvorson, 2007). Canada is trying to budget the costs of its healthcare which in and of itself is not a problem. The problem with Canada’s single payer healthcare system is that it also budgets quality. The quality of healthcare is far too critical to impose rules and regulations that hinder it. America can find ways to cut costs in healthcare without cutting its quality. The single payer healthcare system in Canada would say the source of their unmet needs is the waiting time; whereas those in America cite costs as their biggest obstacle for their unmet needs (O’Neill & O’Neill, 2007). Canada’s single payer system poses several ethical issues because of the way it provides care.


The single payer system would further hinder America’s road to healthcare reform. The single payer system does, in fact, provide universal care, but it destroys the quality of care in the process. The single payer system may be cheaper, but it makes individuals wait for treatments that could potentially save their lives because the government wants to save money. A system that requires patients to wait for treatment because the budget is tight and someone else might need it more is unethical and could generate some serious legal implications by delaying patient treatment. The single payer system saves the government money, but it provides hospitals with less resources and it decreases the quality of care. A single payer system on paper looks like a viable option for healthcare reform, but the costs that it saves bring even more problems and ethical issues.


Flood, C. (2009). Is the Canadian system right for the United States? Journal of Health Politics Policy and Law. doi 10.1215/03616878-2009-016

Glied, S. (2009). Single payer as a financing mechanism. Journal of Health Politics, Policy & Law, 34(4), 593-615. doi:10.1215/03616878-2009-017

Gusmano, M. K., Weisz, D., & Rodwin, V. G. (2009). Achieving horizontal equity: Must we have a single-payer health system? Journal of Health Politics, Policy & Law, 34(4), 617-633. doi:10.1215/03616878-2009-018

Halvorson, G. C. (2007). Understanding the trade-offs of the Canadian health system. Healthcare Financial Management. pp. 82-84. Retrieved from Business Source Premier Database

Oliver, A. (2009). The single payer option: A reconsideration. Journal of Health Politics, Policy & Law. doi 10.1215/03616878-2009-013

O’Neill, J. E., & O’Neill, D. M. (2007). Health status, health care and inequality: Canada vs. the U.S. Forum for Health Economics & Policy, 10(1), 1-43. Retrieved from Business Source Premiere Database

Single-payer system is healthcare stimulus. (2009). Long-Term Living: For the Continuing Care Professional, 58(4), 12. Retrieved from Business Source Premier Database

Ian McIntoshIan McIntosh received his Bachelor of Science degree in Management from Athens State University in August of 2013. He is currently enrolled at Arrhythmia Technologies Institute in Greenville, SC, pursuing a career in Cardiac Rhythm Device Management.