Medicare Expansion and Universal Health Care

Is a single-payer system the answer?

Single Payer System Universal Health Care
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We often hear that the American healthcare system is the best in the world. In reality, the United States ranked eleventh place for health care amongst developed nations in 2011 despite spending the most money. An analysis by The Commonwealth Fund included data on quality, access, efficiency, equity and the health of its citizens. Sad to say, the U.S. ranked last in the latter three categories.

The countries that ranked above the United States on the list had one thing in common - universal health care.

The question is whether or not the United States should follow in those footsteps.

America's Single Payer System

During the 2016 presidential campaign, former Secretary of State Hillary Clinton stated that Medicare was a single payer system. What does that mean?

A single payer system is one where the government, rather than private insurers, manages and pays for your health care. "Single payer" is often interchanged with the phrase "universal health care" in lay terms, though they are not exactly one and the same.

In America, Medicare has been the healthcare system we look to as we grow older. It is a single payer system because the government funds the health care but it is not universal because it does not cover everyone. Instead, it is limited to people 65 years and older or to those with certain disabilities.

Medicare could be expanded and made available to all Americans. In that way, it could become true universal health care.

Such a plan was endorsed by Senator Bernie Sanders of Vermont and came to be known as Medicare for All.

Pros and Cons of Universal Health Care

The truth is that healthcare costs have increased sharply over the years, not because of inflation or the costly medical technology but because of big business and capitalism.

As long as private insurance companies and pharmaceutical companies hold the purse strings, healthcare costs will continue to rise.

A single-payer system would remove the profit-driven motivations for health care but what else does it offer?

For one, everyone would have equal access to care regardless of age, income, or ability. Also, you would no longer have to find a doctor in your "network" because ALL doctors would be in your network. Copays and deductibles would go away. Does it sound too good to be true?

Dollars and cents are not the only cost of universal health care. Americans would need to consider how the plan shapes the care they receive. People who enjoy a private plan today would have to give it up. Wait times for non-emergent services would get longer. With more people in the system, access to their doctor of choice would be affected by longer wait times. Some people may even have to change doctors to access care in a timely manner.

Wait times in countries with universal health care can be long. In Denmark, the mean time to get cataract surgery after the decision is made to treat is 112 days. You may not be able to get a hip replacement in England for 78 days. Elective surgeries in Ireland or Norway will leave you waiting 75 days.

Of course, a single payer system does not come into effect overnight. It would take money and years of effort to organize. In the end, the United States could save in overall healthcare costs but do Americans have the patience to wait their turn?

A Proposal for Medicare Expansion

Some people have recommended expanding Medicare but not necessarily making it available to everyone. During her bid for the 2016 presidency, former Secretary of State Hillary Clinton suggested the eligibility age be decreased to 50 years old during. "Medicare for More" became a motto for Medicare expansion.

The current eligibility age for Medicare is 65 years old.

People in this age group tend to have a number of medical conditions and more medical conditions mean more healthcare spending. At least 87 percent of Americans aged 65 to 74 years old have at least one chronic medical problem. The number increases to 92 percent for those 75 years and older. Taking a closer look, more than 50 percent of seniors over 65 years old have at least two to four chronic conditions while 20 percent of seniors 75 and older have five or more.

The numbers decrease significantly when we look at the younger 50 to 64-year-old population, not currently covered by Medicare. Nearly 72 percent of Americans in this age group have one or more chronic medical problems, 40 percent have two to four conditions and 5 percent have five or more.

Once someone meets eligibility criteria for Medicare, they begin to pay monthly premiums for medical coverage. This money is put into a pool and used to pay for services for all beneficiaries. If younger, relatively healthier Americans were added to that pool, then an interesting thing would happen to Medicare as we know it today. There would be more money to share. Though there would be more people in the pool, there would be a smaller average number of medical conditions to address. This could potentially add years of savings to the Medicare Trust Fund.

Where Do We Go From Here?

U.S. health care could model itself after the successful universal health care systems of other nations. Medicare could be expanded to cover more Americans and maybe even all Americans. Being eleventh best in health care worldwide is not good enough. Our citizens deserve better.


Chronic Conditions Among Older Americans. AARP website.

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally. The Commonwealth Fund website. Published June 2014.

ObamaCare Enrollment Numbers. Obamacare facts website.

Viberg N, Forsberg BC, Borowitz M, and Molin R. International comparisons of waiting times in health care – Limitations and prospects. Health Policy. September 2013; 112 (1-2): 53-61. doi: