Single Payer Health Systems

At its meeting on November 5, 2017, the Ohio Academy of Family Physicians Board of Directors held a focused discussion on single payer health systems.

As a result of referrals from the 2016 Congress of Delegates, the American Academy of Family Physicians Board commissioned RTI International to conduct a study (which resulted in Board Report F that was presented at the 2017 AAFP Congress of Delegates) on the “effects of a national publicly-financed, privately-delivered health care system for all Americans.”

When discussing single-payer health systems, it is very important to specifically define what is meant because the term “single-payer” means different things to different people.  The AAFP study examined three specific models:
  • Medicare for All (a single publicly financed and privately administered system)
  • Bismarck Model (system of statutory health insurance involving multiple nonprofit payers)
  • Public Option (a publically administered health plan that competes for customers against private plans).

Each model was analyzed as to coverage and access, number of general practitioners per 1,000 people, physician satisfaction, expenditures, and population health outcomes. The thing that really stands out is the number of general practitioners in the United States versus other countries who utilize one of these three other health system models. A vastly improved primary physician pipeline and primary care physician-to-subspecialist ratio would be key to making a single-payer system work here in the United States.

The conclusion of the study reads as follows: “In most cases, the effects of different coverage and financing models depend on the specific details of the health care system and proposals for reform.  One consistent finding is that by most measures of health, countries with a single-payer system or universal coverage through a Bismarck model have better overall health outcomes than the United States. Further, these countries spend less per capita and as a percentage of GDP on health care, although they also spend more than does the United States on social supports.  In most cases, physician satisfaction is higher in single-payer and Bismarck health care systems (apart from Germany) than in the United States. The optimal system for the United States may be some combination of components from different models, adapted and customized to fit the unique circumstances in the US.”

Current AAFP policy supports universal access to basic health care services for all people.  The AAFP believes this goal can be attained with a pluralistic approach to the financing, organization, and delivery of health care.  A pluralist health care delivery approach naturally involves competition based on quality, cost and service.

At the present time, the AAFP does not see a viable path that would allow for the establishment of a new, publicly financed, privately administered health care system. The AAFP also does not see the creation and implementation of a true, single-source health care system as viable or even practical as the current economic and political environments do not lend themselves to the development and implementation of such policies.

While this is really a national debate, the OAFP board discussed the current economic and political environments in Ohio and also concluded that creation and implementation of a true, single-source health care system in Ohio is not currently viable.  However, the OAFP can prepare for what might come in the future by working to grow the primary care physician pipeline and improving the primary care physician-to-subspecialist ratio in this country. Also ideas and support can also bubble-up from the state level to the national conversation.  The ultimate goals are for all patients to have access and receive the care they need and for physicians and other health care professionals to find more professional satisfaction in providing that care to patients.

AAFP Resources

Additional Information and Resources