The Sound Bite:

If other first-world countries can make single-payer systems work the United States can too. 

Fact or Fiction?

This is part fact, part fiction. Other countries have a different historical approach to these issues, so their systems are very different from the U.S. model, which offers a complex mixture of public and private insurance programs.

Great Britain for example, has a national health service in which doctors are salaried employees of the government, which also owns and runs the hospitals. Other countries with single-payer systems also have health care budgets, and when the ceiling on spending is near, they can impose long waiting times for care and treatment. 

Medicare does work, but it simply costs more than the systems in other countries. Medicare operates under a fee-for-service structure: The more doctors do, the more they get paid. Under traditional Medicare, beneficiaries can go to as many doctors as they want, as often as they want, as long as they are willing to make co-payments. 

There is no annual budget imposed by the government for Medicare. Spending is unconstrained on a national level. About 25 percent of Medicare beneficiaries are enrolled in Medicare Advantage plans, where they get extra benefits not covered by traditional Medicare, including eyeglasses and routine eye care, dental care and prescription drugs. In return for these extras, they stay within the plan's network of doctors and hospitals. This also drives up spending because the plans collect about 14 percent more from the government than is spent on the typical beneficiary in traditional Medicare. 

The state of Vermont is going to try a single-payer system under a new law that will create a Health Benefits Exchange. "Vermont's plan would include many features common to single-payer systems around the world: a global budget for health care expenditures, guaranteed coverage that is not linked to employment, and a single system of provider payments and administrative rules," according to a report in the New England Journal of Medicine. "The health care delivery system would remain privately owned, however, and the state could contract with a private insurer to perform some functions required of the single payer. It is not yet clear how far the state can go toward establishing a complete single-payer system." 

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