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Single-payer payment system & Privatize Medicare with a voucher system


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In a single payer system the government or a government regulated non-profit agency channels health care payments to collect premiums and settle the bills of medical providers, instead of for-profit insurance companies. Many countries use single-payer systems to cover all their citizens.

The over 1,300 U.S. health insurance companies have different forms and processes for billing and reimbursement, requiring high costs on the part of service providers (mainly doctors and hospitals) to process payments. For example, the Cleveland Clinic, considered a low-cost, best-practices hospital system, has 1,400 billing clerks to support 2,000 doctors. Further, the insurance companies have their own overhead functions and profit margins, much of which could be eliminated with a single payer system. Economist Paul Krugman estimated in 2005 that converting from the current private insurance system to a single-payer system would save $200 billion per year, primarily via insurance company overhead. One advocacy group estimated savings as high as $400 billion annually for 2009 and beyond.

The U.S. system is often compared with that of its northern neighbor, Canada (see Canadian and American health care systems compared). Canada's system is largely publicly funded. In 2006, Americans spent an estimated US$6,714 per capita on health care, while Canadians spent US$3,678. This amounted to 15% percent of U.S. GDP in that year, while Canada spent 10%. A study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of U.S. health care dollars (more than $1,000 per person per year) went to health care administrative costs.

Advocates argue that shifting the U.S. to a single-payer health care system would provide universal coverage, give patients free choice of providers and hospitals, and guarantee comprehensive coverage and equal access for all medically necessary procedures, without increasing overall spending. Shifting to a single-payer system would also eliminate oversight by managed care reviewers, removing a potential impediment to the doctor-patient relationship.

Although studies indicate Democrats tend to be more supportive of a single-payer system than Republicans, none of the reform bills debated in the U.S. Congress when the Democrats had a majority from 2007–2010, included proposals to implement a single payer health care system. Advocates argue that the largest obstacle to single-payer, universal system in the U.S. is a lack of political will.

Privatize Medicare with a voucher system
Rep. Paul Ryan (R) has proposed the Roadmap for America's Future, which is a series of budgetary reforms. His January 2010 version of the plan includes the transition of Medicare to a voucher system, meaning individuals would receive a voucher which could be used to purchase health insurance in the private market. This would not affect those near retirement or currently enrolled. A series of graphs and charts summarizing the impact of the plan are included. Economists have both praised and criticized particular features of the plan. The CBO also partially scored the bill.


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