Definition of Single Payer Terms

1) Universal:
All residents of a geographic/political entity; includes everyone, regardless of medical condition; a vast pool that guarantees affordable costs; "Everyone in, nobody out", (In some single payer plans, there are waiting periods for newcomers, but then they are included.)

2) Single Payer Health Care:
Everyone's health care is paid for out of one publicly administered trust fund which replaces our current multi-payer system.
     1) provides all residents with comprehensive health care coverage
     2) assures freedom to choose M.D.s, Nurse Practitioners, and other health care professionals, facilities, and services
     3) eliminates the role of insurance companies

3) Social Insurance:
Administered by a public agency, not commercial entities; directed to a social goal - to promote the nation's health through universal access to care the nation can afford - rather than to make money; all members of society are in one risk pool, not 1500 pools each trying to avoid risk; higher percentage collected funds go to care (97 percent vs 60-75 percent).

4) Comprehensive:
Coverage which includes all services determined by physicians, nurses, and other health professionals to be necessary.  Includes rehabilitation, long term and home care, mental health care, prescription drugs, medical supplies, preventive and public health measures, in addition to all acute services.

5) Capitation:
Prospective, flat-fee payment, by insurer to provide, based on the number of patients listed with that provider, without regard to actual health service needs.  When a patient requires higher than average level of care, the patient's provider must absorb the extra cost.  Conversely, when the lower than average level of care is required, the provider absorbs the savings. Creates financial incentive for provider to limit care options offered to patients, to shun patients with complex needs, while trying to attract young, healthier patients. 

6) Consolidated health care finance:
One agency budgets, collects and disburses the money to pay for care, similar to Medicare in which administrative costs take only 2-3 percent of overall health expenditures.

7) Administrative Overhead: Portion of health care expenditures consumed by clerical and technological support for filing and re-filing claims, denial/payment of claims, advertising, executive salaries.  While Medicare administrative costs take only about 2-3 percent of their expenditures for administration costs, the lowest percentage for any private insurer is 14 percent.