Urban Wire What would it take to make single-payer health care a reality?
Justin Milner, Vicky Gan, Yifan Powers
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Media Name: 20180130.jpg

Efforts to repeal the Affordable Care Act have subsided in the last few months, but the debate over health care continues to evolve. And when the conversation heats up again, the concept of a single-payer health system is sure to be in the mix.

Public support for single-payer has risen considerably in the past few years. In a recent poll, 49 percent of voters said they support a single-payer health care system in which all Americans would receive their health insurance from one government plan. And in September 2017, Vermont senator Bernie Sanders introduced his version of single-payer, called “Medicare for All,” with 16 prominent Democratic cosponsors.

But proponents of a single-payer approach need to provide greater clarity about how it would work in the US.

In the latest episode of the Urban Institute’s podcast, Critical Value, senior fellow Linda Blumberg discusses the appeal of single-payer health care and the tough questions and trade-offs that would have to be addressed to make it a reality.

One important question: How would we pay for it? No matter how a single-payer system is structured, it would increase government spending dramatically. The Urban Institute estimated that the single-payer plan Sanders proposed in 2016 would have cost an additional $32 trillion in federal spending over 10 years.

Another key question: How much change can Americans tolerate? Switching to single-payer would upend the health care system we have now—with all the growing pains that entails. People may not be able to see the same doctors they had before, or they may be compelled to buy health insurance even if they don’t want it.

Under a single-payer system, some people would pay more, and others would pay less. Some people would receive more benefits than before, and others would have less flexibility to choose where they receive their care. Payments to health care providers would change. These benefits and costs would be distributed in different ways, depending on the system’s design.

The current enthusiasm around single-payer shows that many Americans want a better health care system. But before committing to any reforms, we need to take a closer look at the details.

Critical Value is hosted by Justin Milner and produced by Vicky Gan and Yifan Powers. To reach the podcast team, please email [email protected].


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The Urban Institute podcast, Evidence in Action, inspires changemakers to lead with evidence and act with equity. Cohosted by Urban President Sarah Rosen Wartell and Executive Vice President Kimberlyn Leary, every episode features in-depth discussions with experts and leaders on topics ranging from how to advance equity, to designing innovative solutions that achieve community impact, to what it means to practice evidence-based leadership.


Research Areas Health and health care
Tags Health insurance Federal health care reform Health care delivery and payment Medicare
Policy Centers Health Policy Center