Single-Payer Health Care

What is Single Payer Health Care?

Single payer—or Medicare for All—is simply a streamlined financing mechanism where one entity administers the health care funding and payments. It expands the cost-effective and administratively efficient Medicare program to cover everyone in the United States. Health care delivery (such as hospitals and doctors) remains private and patients are guaranteed choice of care from providers.

Myths Facts
Single Payer health care would create a government-run health care system or “socialized medicine.” Single payer creates a national insurance system by collecting and administering funds through a single public agency. Hospitals and doctors remain private providers but get reimbursed directly from this public system.
Greater government involvement in health care would lead to rationing—with a bureaucrat making your health care decisions. Currently, most private insurance companies restrict your choice and ration your care. With a single payer system, patients have a choice of provider, decisions are made between provider and patient, and the provider is assured fair and prompt payment.
Moving toward a single payer health care system would disrupt patient care. Extending Medicare insurance to the entire population would be relatively simple because the system is already established and nearly all providers are existing Medicare providers.

Why Single Payer?

The Council supports the insurance expansions included in the Affordable Care Act, but while this reform is welcome, it does not address many inequities of the health care system. For-profit insurance companies still control much of the health insurance system, devoting billions to marketing and shareholder dividends. Limited provider networks and excessive cost sharing will continue to reduce access and choice. Managed care and prior authorizations will still limit the treatments a provider can prescribe. The system will still be fragmented, causing confusion for patients, complications for providers, and limiting the negotiating power of payers. Over 30 million Americans are projected to remain uninsured. We can do better.

The National Health Care for the Homeless Council supports H.R. 676, the Improved Medicare for All Act, as well as state-level efforts to institute single payer health systems. Such as system would best serve those experiencing homelessness and the nation at large. Please view the documents and links to partners below for more information.

Recently, Medicare for All has gained national attention as Democratic Presidential hopeful Senator Bernie Sanders introduced his plan, Medicare for All: Leaving No One Behind. Numerous attacks have come out against the plan calling it unrealistic, too costly, and bashing it for raising taxes. These concerns have been addressed in a number of responses, including from Professors David Himmelstein and Steffie Woolhandler, and Physicians for a National Health Program. An earlier version of Senator Sander’s bill, S. 1782 American Health Security Act of 2013 has yet to be updated but is expected to be released soon.

For more see: From Obamacare to Improved Medicare for All | Slides from National Nurses United at National HCH Council Regional Training, August 2014


Additional Resources:

Bills to Support:

  • H.R. 676: Expanded and Improved Medicare for All –  Introduced by Representative John Conyers Jr. (D-MI13), establishes a Medicare for All Program to provide all individuals residing in the U.S. with health care. The bill restricts participation to public or nonprofit institutions, allowing private insurers to sell benefits not deemed medically necessary and already covered by the bill.
  • H.R. 1200: American Health Security Act of 2015 – Introduced by  Representative Jim McDermott (D-WA7), aims to create a Medicare for All Single Payer system, recognize health care as a human right, and provide flexibility to states. The bill establishes a state-based program that eliminates other federally funded health care programs and prohibits the sale of private health insurance that duplicates benefits provided.
  • H.R. 3241: State Based Universal Healthcare Act of 2015 – introduced by Representative Jim McDermott (D-WA7), amends the Affordable Care Act (ACA) to authorize State-based universal health care systems. Under the ACA, states can create their own form of health care insurance starting on January 1, 2017, otherwise known as a Section 1332 waiver. The waiver provides an opportunity for states to create alternatives such as a public option, but restrictions in the ACA prohibit states from creating a single payer system. A true single payer system includes everyone, and as Vermont’s attempt demonstrated, having a system that allows large employers to maintain their insurance and keeps federal health programs like Medicare in place makes a single payer system difficult to implement. H.R. 3241 would remove these barriers and allow states to access federal health care dollars that would otherwise be spent on private marketplace subsidies.

Get Involved:


  • Fix It: Healthcare at the Tipping Point | Released in 2015, this documentary makes the business case for a Single Payer health care system.
  • Escape Fire: The Fight to Rescue American Healthcare | From 2012, this documentary explores the fee-for-service system, still relevant during a time as the industry shifts towards value-based healthcare under the ACA.
  • The Waiting Room | Released in 2012, the Waiting Room tells the story of the day-to-day struggles of a safety net hospital in Oakland, CA. The Waiting Room Storytelling Project continues the story.
  • Money Driven Medicine | From 2009, this pre ACA documentary examines the economics that drives the health care industry.
  • Sick Around the World | From 2008, this documentary features T. R. Reid who examines the health care systems of the United Kingdom, Japan, Germany, Taiwan and Switzerland to see what the United States can learn from their successes.
  • Sicko | From critically acclaimed director Michael Moore, this 2007 documentary takes on the U.S. health care system and presents the case for universal health care.

Single Payer in the News

Financial Burden Under Current Health System:

Comparing Single Payer to Other Health Systems:

Quote of the Day:

Written by Physicians for a National Health Program’s Senior Health Policy Fellow Don McCanne, MD, Quote of the Day is a subscription health policy update, taking an excerpt or quote from a health care news story or analysis on the Internet and commenting on its significance to the single-payer health care reform movement. To subscribe to Dr. McCanne’s daily updates, visit