# Difference between Universal Health-care and a Single Payer system **URL:** \ **Category:** Factual Questions\ **Created:** [September 9, 2008, 2:01am UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721 "2008-09-09T02:01:29Z")\ **Posts on this page:** 16\ **Page:** 1
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [September 9, 2008, 2:01am UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/1 "2008-09-09T02:01:29Z")
In a MPSIMS thread where I’m discussing universal health-care, I asked what the difference is between UHC and a single payer system. No one has answered, but I’m still curious, so I’m taking another stab at it. And for those who say, Google it, I’ve already tried, but I guess I’m not smart enough to understand the difference:( But seriously, I…vaguely…understand a little. This is my guess of the difference: UHC would mean that tax dollars would go to the government, who would then provide health-care coverage like a private insurance company, right? Whereas, with a single payer system, the government would take your money, and instead of providing coverage themselves, would pay one or more private insurance providers that you could choose from? Am I close? ---
**Author:** ![Tim\_T-Bonham.net](https://avatars.discourse-cdn.com/v4/letter/t/46a35a/32.png) [@Tim\_T-Bonham.net](https://boards.straightdope.com/u/Tim_T-Bonham.net)\ **Post date:** [September 9, 2008, 6:56am UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/2 "2008-09-09T06:56:51Z")
> [@Nobody](#): > > Am I close? Not really. Universal Health Coverage means that everyone has some kind of health coverage. There are various ways this could be accomplished:[ul] [li] a single-payer government system (like Medicare for seniors)[/li][li] a single-payer private system (like if everyone was automatically enrolled in Blue Cross or a similar private insurer) [\*] a multiple-payer government-funded private system (where each person chooses an insurance company, but the government pays the premium (or a specific amount toward the premium))[/li][li] a multiple-payer system where each person, or each person & their employer pay the premiums (with a legal requirement that all people have health insurance, like auto insurance is mandated in most states)[/li][li] and probably several other variations.[/li][/ul] Single-payer is a system where there is a single organization that pays for all health care costs. The point of this is that it would greatly reduce the amount of paperwork & bureaucracy involved in the health care system. Most such systems issue each person a card similar to a credit card, which they use to ‘pay’ for any medical services. Then the single-payer organization pays the medical provider. Single-payer is one version of a universal health care system, but not the only one. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 9, 2008, 7:02am UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/3 "2008-09-09T07:02:16Z")
Universal health care describes the range of services covered; single-payer is one administrative mechanism to provide for payments under a UHC system. I don’t think your definition of single-payer is accurate, because as soon as you involve private insurers, you’ve got more than one payer. Single-payer, as I understand it, is just that - there is only one payer to the doctors, hospitals, etc. That’s how it works in Canada. Each province establishes a health care commission (exact names will vary), and give that Commission funding from tax revenue. That Commission then pays all doctors, hospitals etc., giving them each the same rate and using the same administrative structure, so they don’t have to use different forms and procedures for different groups of patients, as happens when there are numerous different insurers, each with their own forms and conditions. Universal health care means that everything is covered, but there can be a lot of debate about what “everything” is or should be. In Canada, the system covers medical expenses, but not most dental, pharmacy, chiro, or physio expenses (but these things may be covered when you’re in a hospital, if considered medically necessary, so it’s not absolutely clear-cut). ---
**Author:** ![Balthisar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/balthisar/32/2825_2.png) [@Balthisar](https://boards.straightdope.com/u/Balthisar)\ **Post date:** [September 9, 2008, 12:28pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/4 "2008-09-09T12:28:11Z")
> [@Northern\_Piper](#): > > In Canada, the system covers medical expenses, but not most dental, pharmacy, chiro, or physio expenses[.] What the heck is a “chiro”? In Canada, it’s only single payer within the province, i.e., each province acts as the single payer within its borders. Provincial funds are use in addition to federal money. Contrast Canada with Mexico, which has universal health care (and it’s even guaranteed by their constitution). The Mexican system isn’t a single payer system however, and it’s perfectly legal (and if you’re middle class, preferred) to pay private doctors and dentists with private funds and private insurance, and so you have the right to choose the level of care that you can afford. The only way to do that in Canada is to go to the United States, although I believe there was Quebec case that may have opened the door to private insurance and care. Of course if you compare both of those to the US system, then it appears we’re just a big cluster hump. Laugh if you will, but adopting a Mexican-style system seems like an excellent step if we’re going to be forced to change. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 9, 2008, 12:35pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/5 "2008-09-09T12:35:51Z")
“chiro” = chiropractic Not all of the provinces had the same ban on private insurance as Quebec did, so it’s not appropriate to generalize that to the entire Canadian system. ---
**Author:** ![Hypnagogic\_Jerk](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hypnagogic_jerk/32/4252_2.png) [@Hypnagogic\_Jerk](https://boards.straightdope.com/u/Hypnagogic_Jerk)\ **Post date:** [September 9, 2008, 1:48pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/6 "2008-09-09T13:48:13Z")
> [@Balthisar](#): > > The only way to do that in Canada is to go to the United States, although I believe there was Quebec case that may have opened the door to private insurance and care. There is a private health care system in many Canadian provinces. My understanding is that what was decided in the Chaoulli judgement is that banning Canadians from buying private health insurance was unconstitutional. Allowing the sale of private insurance is probably going to make it more attractive to use the private health care system (and make it grow), but you could have used it before, by paying the bill yourself. And I didn’t know that not all provinces had a law banning the sale of private health insurance, thanks **Northern Piper**. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [September 9, 2008, 1:48pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/7 "2008-09-09T13:48:44Z")
> [@Northern\_Piper](#): > > Universal health care means that everything is covered, but there can be a lot of debate about what “everything” is or should be. Universal health care means that every_one_ is covered, not every_thing_- although everything usually is covered under UHC. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 9, 2008, 1:55pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/8 "2008-09-09T13:55:33Z")
see? we can’t even agree on our terms! 🙂 ---
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [September 9, 2008, 2:25pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/9 "2008-09-09T14:25:46Z")
Thanks for all of the replies. I think I understand things a lot better now. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 9, 2008, 2:55pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/10 "2008-09-09T14:55:36Z")
> [@Hypnagogic\_Jerk](#): > > My understanding is that what was decided in the Chaoulli judgement is that banning Canadians from buying private health insurance was unconstitutional. No, the [Chaoulli](http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html) decision doesn’t go that far - there was no majority decision that the ban on private insurance was unconstitutional. The Court sat a seven-judge panel, and there were three different sets of reasons delivered Three of the judges (McLachlin C.J. and Major J. (Bastarache J. concurring) held that the ban violated s. 7 of the _Canadian Charter of Rights and Freedoms_; three other judges said it didn’t (Binnie and LeBel JJ. (Fish J. concurring)). The seventh judge, Deschamps J., decided the case solely under the Quebec _Charter of Human Rights and Freedoms_, which is a statute passed by the Legislature of Quebec. She found that the ban on private insurance violated the Quebec Charter. Since that was enough to decide the case, she did not consider the _Canadian Charter_. The three judges who thought the provision infringed the _Canadian Charter_ agreed with Deschamps J. that the ban infringed the Quebec Charter - so that’s the holding in the case. It leaves open for another day whether the ban would violate the Canadian Charter and would be unconstitutional. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [September 9, 2008, 4:23pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/11 "2008-09-09T16:23:41Z")
If UHC is so good, then why the need for additional private insurance? What would that cover that UHC lacks? (re Canada) ---
**Author:** ![Nobody](https://avatars.discourse-cdn.com/v4/letter/n/94ad74/32.png) [@Nobody](https://boards.straightdope.com/u/Nobody)\ **Post date:** [September 9, 2008, 4:37pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/12 "2008-09-09T16:37:25Z")
> [@jtgain](#): > > If UHC is so good, then why the need for additional private insurance? What would that cover that UHC lacks? (re Canada) From what I’ve seen and heard in my other thread, and other places, there are three reasons for this. First, my understanding is that not all doctors have to accept UHC, and can only accept private insurance if they want. Also, I saw it said a couple of times, that things like dental aren’t covered under Canada’s UHC. Third, in the other UHC thread, Johnny L.A. said > [@](#): > > If, like the German system, private insurance gets you a private hospital room or gets you to the head of the line when you go to a doctor, then this might be attractive to some people. ---
**Author:** ![Balthisar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/balthisar/32/2825_2.png) [@Balthisar](https://boards.straightdope.com/u/Balthisar)\ **Post date:** [September 9, 2008, 5:33pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/13 "2008-09-09T17:33:56Z")
> [@jtgain](#): > > If UHC is so good, then why the need for additional private insurance? What would that cover that UHC lacks? (re Canada) Sometimes (and not specifically related to Canada) there can be issues with access to doctors in a timely manner, the quality of the facilities, the quality of the doctors or the care, or the types of treatments that are allowed. You see the exact same thing in the United States – which insurance company is better than the other? If Blue Cross/Blue Shield is so good, then why the need for the competition? ---
**Author:** ![Hypnagogic\_Jerk](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hypnagogic_jerk/32/4252_2.png) [@Hypnagogic\_Jerk](https://boards.straightdope.com/u/Hypnagogic_Jerk)\ **Post date:** [September 10, 2008, 11:43pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/14 "2008-09-10T23:43:42Z")
> [@Northern\_Piper](#): > > Three of the judges (McLachlin C.J. and Major J. (Bastarache J. concurring) held that the ban violated s. 7 of the _Canadian Charter of Rights and Freedoms_; three other judges said it didn’t (Binnie and LeBel JJ. (Fish J. concurring)). > > The seventh judge, Deschamps J., decided the case solely under the Quebec _Charter of Human Rights and Freedoms_, which is a statute passed by the Legislature of Quebec. She found that the ban on private insurance violated the Quebec Charter. Since that was enough to decide the case, she did not consider the _Canadian Charter_. This is why we always need a lawyer. 😉 Thanks **Northern Piper** , very instructive. ---
**Author:** ![Spoons](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/spoons/32/3141_2.png) [@Spoons](https://boards.straightdope.com/u/Spoons)\ **Post date:** [September 11, 2008, 12:09am UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/15 "2008-09-11T00:09:23Z")
> [@Hypnagogic\_Jerk](#): > > This is why we always need a lawyer. 😉 Thanks **Northern Piper** , very instructive. I’ll add my thanks as well. I remember the _Chaoulli_ decision coming down, and a very confusing explanation from a law professor at the time. Now I understand why it’s not binding on the other provinces–thanks again! ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [September 13, 2008, 2:49pm UTC](https://boards.straightdope.com/t/difference-between-universal-health-care-and-a-single-payer-system/462721/16 "2008-09-13T14:49:49Z")
of course, there’s also the question of whether a majority of the Court in the future would find Deschamps J.'s analysis under the Quebec Charter can transpose to s. 7 of the Canadian Charter -which seemed to be the view of McLachlin CJC.