Maryland's single-payer initiative

Amy Higgins

Obtaining health insurance is not so easy for some Americans. They might be unemployed and unable to obtain employer-sponsored health insurance. They may have health problems that ring alarm bills for insurance providers. Or perhaps they simply can't afford to pay for coverage on their own. According to Baltimore HealthCare Access, more than 600,000 Marylanders are uninsured.

Some Maryland lawmakers and grassroots organizations believe the solution for the state's health care woes rests with a single-payer system. A Maryland Senate bill called the Maryland Health Security Act of 2011 seeks to do just that.

What is single-payer?

A single-payer health insurance system involves a single public entity overseeing all health financing, according to Physicians for a National Health Program. All citizens, employers and even the state pay into the same pool, which pays for universal health care. While the funding is public, hospitals and doctors remain private. Canada, for example, has a single-payer system.

The notion of a national single-payer system briefly surfaced during the debate about federal health care reform. Yet it was dismissed amid controversy and opponents' concerns that a single-payer system would constitute a government takeover of health care.

Maryland's single-payer bill

Sponsored by 11 senators, the Maryland Health Security Act of 2011 is the latest attempt at enacting a single-payer system in the state. According to the Maryland General Assembly website, the bill would streamline Maryland health care by:

  • Establishing the Maryland Health System. The system would be headed by a board, which would determine what the comprehensive health package that all residents would get would include.
  • Requiring the health system to provide care to all residents of the state under a single system that is not dependent on employment. Citizens could choose where they get care and which doctors they see.
  • Requiring the health system to reimburse a member who receives health care services from an out-of-state health care provider under specified circumstances.

Single-payer support

Those who support a single-payer system argue that it would lower costs, according to grassroots group Healthcare Now of Maryland. One reason so many are without health insurance coverage is its high price. But why is the price so high? Physicians for a National Health Program says it's because private insurers waste money on things that have nothing to do with health care, like overhead, underwriting, billing, sales, marketing and executive pay.

To boot, the administrative staffs doctors and hospitals must employ to deal with the insurance bureaucracy are costly, Physicians for a National Health Program says. If all of these operating costs can be taken out of the picture, supporters of single-payer systems say, the savings alone could pay for everyone's comprehensive health coverage.

Single-payer skepticism

Physicians for a National Health Program says other advanced nations provide comprehensive coverage to their entire populations, while the United States leaves millions completely uninsured and millions more inadequately covered. That may be true, but many Americans wonder whether a single-payer health care system could succeed in the United States.

Single-payer systems usually leave no need for private health insurance companies. Physicians would be forced to accept the reimbursement rate offered to them by whatever entity steps in to take their place, rather than negotiating rates with various insurance companies.

Therefore, critics say, health care providers would earn less money under a single-payer system. This would affect the quality of care that patients receive and might sway prospective doctors from committing to a career in health care, according to Dr. Robert A. Book of the Heritage Foundation, a conservative think tank. Lower pay also would lead to less investment in medical equipment, according to Book, which would lower the quality of health care.