Medicare Eligibility and Financing: Single-Payer System

Medicare Eligibility and Financing
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Medicare Eligibility and Financing
Introduction/Background Information
A single-payer system is a referred to as the type of a universal healthcare coverage in which the respective costs of care services for the population are covered by a single public insurance plan. Instead of having multiple and competing providers of healthcare insurance, a single public agency takes full responsibility and role in the financing of the healthcare for the entire population. As posited by Petrou et al. (2018), in a single-payer system, healthcare expenses are paid for by a single public authority, not a private authority or a mix of both. Every resident is thus accorded the opportunity of having coverage under one health insurance plan, allowing them to access necessary services such as hospitals, long-term care, prescription drugs, vision care, doctors, and dentists. In a single-payer system, the government is the only "single payer" and is solely responsible for paying the healthcare expenses of the entire citizens using the money that has been collected through the taxation system. The case of such a single-payer system is true in more than seventeen countries globally, some of which, to mention a few, include Canada, Japan, Italy, United Arab Emirates, and Iceland. This paper examines single-payer systems to contribute to the understanding of how it affects medical insurance eligibility and financing.
How a single-payer system works in the United States
For the United States, the case is different. A single-payer system can also be implemented without necessarily providing health coverage for the entire population. It is possible for a country to have a single-payer program and still not achieve universal coverage, and this is true for the case of the United States. In the United States, as informed by Dillender (2017), there is a combination of single-payer coverage for some people, and private coverage for others, while millions of the population are underinsured or have no coverage at all. Therefore, in the U.S., Veterans Health Administration and Medicare for All are the only examples of a single-payer system. As reported by R. W. Johnson Foundation (2019), Medicaid is sometimes confused with being a single-payer system, but it is not, as it is usually jointly funded by both the U.S. federal government and each of the state governments. Medicare for All, for instance, consists of Parts A (hospital care), B (physician care), C (Medicare Advantage), and D (prescription drugs). The eligible American population for these health insurance coverages are only people with disabilities and those aged 65 years and above. Besides, Veterans Health Administration is insurance coverage that caters for all the care expenses of only the veterans, those who served in the air, military, or naval services, and were released or discharged therefrom under specific conditions other than dishonorable (Dillender, 2017). Therefore, the single-payers systems only cater for the healthcare expenses of some selected groups of the American population and not all people.
Benefits of having such a single-payer system
For different countries with a single-payer system, numerous benefits have been recorded. The single-payer system promotes the provision of universal healthcare coverage. All the members of the country’s eligible population are fully insured when seeking health care services. The situation enhances the aspect of equity as all the residents have the same coverage, which is vital for redressing the income and racial-related disparities that prevail within the coverage and access to care services (Petrou et al., 2018). As deliberated by Petrou et al. (2018), the increased coverage of the entire population, consequently improving equitable access to care, is further expanded by the consideration that the residents are not required to incur high out-of-pocket costs at different point of service. The coverage is also continuous, and people are not exposed to the risk of losing or needing to change it when their status, income, age, jobs, or residence change.
Single-payer systems also foster the broad-based strategies for implementing cost-containment. With all the insurance providers and the associated public consumers within the same system, there is an increased potential for implementing an effective system-wide cost-containment strategy. The government run-system has the capability of regulating payment methods for the providers and the associated incentives have effects on all the providers serving the insured people. The strategy can be substantially challenging to implement under a fragmented health insurance system. The situation thus fuels the possibility of the government dismantling the administrative structures often linked with the provision of health insurance coverage to the residents, which results in savings (Petrou et al., 2018). Therefore, without the need to pay for premiums, insurer-specific provider networks, or cost-sharing requirements, individuals find it less administratively complex to interact with the healthcare systems as they can have increased access to quality care services.
A single-payer system further eliminates the surprise billing and healthcare distribution costs challenges. Healthcare providers often independently make the decision on the insurers to participate and collaborate with, making it hard for the patients to identif...