Lessons for the United States from single-payer systems

Scott L Greer, Holly Jarman, Peter D Donnelly

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


US political debates often refer to the experience of "single-payer" systems such as those of Canada and the United Kingdom. We argue that single payer is not a very useful category in comparative health policy analysis but that the experiences of countries such as Canada, the United Kingdom, Spain, Sweden, and Australia provide useful lessons. In creating universal tax-financed systems, they teach the importance of strong, unified governments at critical junctures-most notably democratization. The United States seems politically hospitable to creating such a system.The process of creation, however, highlights the malleability of interests in the health care system, the opportunities for creative coalition building, and the problems caused by linking health care finance and reform. In maintaining these systems, keeping the middle class supportive is crucial to avoiding universal health care that is essentially a program for the poor.For a technical term from the 1970s, "single-payer health care" has proved to have remarkable political power and persistence. We argue it is not a very useful term but the lessons from such systems can be valuable for those contemplating movement toward universal health coverage in the United States.

Original languageEnglish
Pages (from-to)1493-1496
Number of pages4
JournalAmerican Journal of Public Health
Issue number11
Early online date2 Oct 2019
Publication statusPublished - Nov 2019


  • Global Health
  • Health care reform
  • Humans
  • Politics
  • Single-payer system/organization & administration
  • State medicine/organization & administration
  • United States
  • Universal health insurance/organization & administration


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