Unlike the vast majority of Americans who get sick, President Trump is reaping the benefits of single-payer, single-provider health care.

He doesn’t have to deal with networks, deductibles, or co-pays at Walter Reed National Military Medical Center. The president will not face the familiar onslaught of paperwork, the confusing “explanations of benefit,” or the ongoing bills that distract so many Americans as they attempt to recuperate from their illnesses.

Those covered by Medicare, as Mr. Trump would be if he were a private citizen, must also navigate supplementary coverage and a complex and often confusing web of rules and regulations.

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The president’s health care is free at the point of delivery, funded from general taxation, and paid for by all taxpayers.

The Defense Health Agency, which operates Walter Reed, is one of a handful of single-payer, single-provider health systems in the United States. These are fully socialized health systems. Others include the Veterans Health Administration, public correctional health systems, and much of the Indian Health Service.

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These health care systems provide care that is free at the point of use, based on need, not on ability to pay. The costs are covered by general taxation, not insurance or user fees. The staff in these systems are paid salaries, so they are not incentivized to provide more or pricier care that may not be medically necessary.

Most of those eligible for government-funded health care in the U.S., including Medicare and Medicaid beneficiaries and public employees, do not receive government-provided care. These government-funded systems function as voucher programs, and the programs themselves are often administered by private insurance companies. Eligible individuals can use these vouchers to receive care at participating private health care facilities, and must navigate a complex system of eligibility requirements, participating providers and, of course, endless paperwork, to receive the care they need. These systems are programs of government-purchased health care, not government-provided health care

The British National Health Service (NHS) is the largest single-payer, single-provider health care system in the world. When it was founded in 1948, the government reminded the population that the NHS was not free, and it was not “charity.” It was paid for by everyone through taxes.

In parliament, Nye Bevan, the Welsh coal miner who was the visionary behind the creation of the NHS, stated the intention to “universalize the best,” to ensure that this publicly funded system provided the highest standard of care to everyone. Bevan felt strongly that a just health care system must include everyone, not only the neediest, writing “the essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability, and wealth is not advantaged.”

A single-payer system might accomplish this in a variety of ways, but only a single payer, single-provider system removes market incentives and the tangle of networks, contracts, and paperwork that blight the American system.

The NHS has become a beloved British institution, lauded everywhere from the Olympic opening ceremony to a cake on the Great British Baking Show. When a single-payer, single-provider system works well and is properly funded, need is the only criterion for receiving care. That means a patient and her family can get care without worrying about preauthorization, payment plans, surprise bills, or out-of-network specialists.

All health care systems have tradeoffs, and the National Health Service is no exception. Providing care on the basis of need means patients may not be able to choose where and when they receive elective care and may not, for example, be able to ask for additional diagnostic procedures like MRIs to achieve peace of mind. In recent years, the NHS has been severely underfunded, leading to some challenges in accessing care, and overwork and burnout among its staff.

While President Trump and his family can now focus on his recovery from Covid-19 and his health, few sick Americans have the same opportunity for high-quality health care without a morass of paperwork and bills. Whether they are among the millions of uninsured, including tens of millions who have lost access to employer-sponsored insurance in the current recession, or whether they must navigate government-funded Medicare or Medicaid or employment-based insurance, they are caught in a system where mountains of forms and impenetrable eligibility and payment policies stand between patients and their needed treatment.

The president’s experience with single-payer, single-provider health care shows us there is a better way.

Rebecca Kolins Givan is an associate professor in the School of Management and Labor Relations at Rutgers, the State University of New Jersey, and the author of “The Challenge to Change: Reforming Health Care on the Front Line in the United States and the United Kingdom” (Cornell University Press, 2016).

  • We are well past the time to put a system like this to work in the USA – alleged to be a great place to live, work and play. The only barrier is the profit over people motive from selfish people, companies and insurance companies.

  • Really??? The VA and British NHS as the model? Have you EVER been in a VA or NHS hospital? You can find them by looking for long lines of sick folks. I’ve worked in both and the- average working American would cringe if a family member was sent their.

    Just really silly.

  • BTW-
    IF THE GREAT UK SYSTEM OF HEALTHCARE SERVES THE PEOPLE SO WELL, THEN WHY DID IT INSPIRE THE BIGGEST DIAMOND-HEIST IN HISTORY?
    SEE THE MOVIE : FLAWLESS. STARRING MICHAEL CAINE & DEMI MOORE (2007).
    WHY DO YOU CHOOSE TO PROPOSE TO REPLACE A SYSTEM THAT HAS CLEARLY FAILED SO MANY PEOPLE FOR SO LONG WITH A DIFFERENT SYSTEM THAT HAS CLEARLY FAILED SO MANY PEOPLE FOR SO LONG?

  • The current U.S. healthcare “system” (more like a Rube Goldberg contraption) is and has remained dysfunctional mostly because the Republican party does not want universal healthcare. The GOP credo is that in America, the poor have too much money, and the rich don’t have enough money. Everything that they do a based upon this credo.

  • YES, I AGREE WITH YOU. WE ALL SHOULD RCV WHAT TRUMP GETS, INCL. FREE TRANSPORTATION BY ROAD & BY AIR, FREE PERSONAL SECURITY TEAMS, FREE ROOM & BOARD.
    OUR COUNTRY IS SO BACKWARD!!
    WHEN WILL WE WAKE-UP AND GIVE TO ALL THE THINGS THAT TRUMP GETS FOR FREE.
    AFTER ALL, THE TAXPAYERS WILL PAY FOR IT, RIGHT?
    SO, WHO CARES, REALLY?

  • Unlike the rest of us, federal level politicians receive the best quality healthcare. It’s not just the President – House and Senate members and Supreme Court Justices also receive top of the line care. Like Trump, the late Ruth Bader Ginsburg had access to the best care available.

  • Have you ever been to a VA hospital? You are out on a list and told to come back in 8 months if you live that long. Plus think about the current situation we are in right now. The government told you to stay home. You go to the store to get milk for the kids and catch COVID-19. They tell you we are not going to cover your health cost because we told you to stay home and you didn’t. So know you are on your own.

  • So how do we get the politicians, health insurance lobbyists, and Big Pharma to morph from the current medical-industrial complex to a system that is less profit-driven? Yeah, that’s what I thought. No one wants to give up profit.

  • Without a single payer or universal health care, USA shows that we don’t care about the less privileged. And this is exactly why >200,000 have died and we have gone about as if nothing has happened.

  • Indeed, based on the current epidemic response and outcome (assuming the reported data are truthful), the best healthcare system seems to be the German one. Which is relying on reined in private insurance, and yet providing affordable universal healthcare, and could be more easily, and realistically, implemented in the US.

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