Single payer is heavily supported by the healthcare industry, has easy implementation and transition, and is cost-effective—multiple warrants.

APHA has called for universal coverage of health care for all U.S. residents for decades.[32] This has included calls for a unified, nationally coordinated, and nationally funded approach (i.e., SP) to health care expenditure since the late 1970s. This goal for coverage, met by the majority of other developed countries in the world, is no longer in question, but the best approach is still being debated in policy and political spheres. In this debate, the evidence in support of SP has grown rapidly in the past decade. In addition, recent polls conducted with broad clinician samples have shown that a majority of doctors “strongly support” policy reform to implement SP.[33] The American College of Physicians (ACP), the second largest provider organization in the United States, has also recommended that U.S. policy initiate a transition to a system of universal coverage, through either an SP or a public payer choice capable of supporting universal coverage.[34]  Single-payer health system: In 1993, the APHA leadership and executive board developed 14 Points on Health Reform in order to organize and guide the essential criteria for reform of public health.[35] These points continue to guide the principles of the public health field in developing proposals for national health reform.[36] Overall, the evidence clearly demonstrates that SP is the most optimal structure for health reform in order to support these principles.  Designing, implementing, and transitioning to a single-payer system may entail significant changes in the sources and extent of coverage, provider payment mechanisms, and financing of health care services in the current U.S. health care system.[37] The federal government could administer some functions of the single-payer health plan at the national level and delegate other functions to state and local governments. Alternatively, state governments could administer the single-payer health plan with broad federal oversight.[37] Single-payer system implementation can be done in incremental stages starting with people who have health insurance coverage through various public sources (Medicare, Medicaid/ Children’s Health Insurance Program, Veterans Administration) who could continue to have such coverage under a single-payer system, although covered benefits and cost-sharing agreements might change.[38] People who have private insurance (primarily employer-based insurance) may enroll in the public plan and might retain private coverage that supplements the coverage under the public plan, preserving public financing and redistributing revenues among the pools to attenuate risk selection.[39] With regard to health insurance, several countries progressively transitioned from multiple large insurance pools to single-payer systems while building the financial and administrative capacity to establish a single insurance pool. An alternative approach would be to first standardize the health plans that can be offered in the market.[38] All of these approaches may be slowed by legal challenges from states or business interests, but they each reflect a lower risk as changes to taxation and federal program reimbursement do not involve the constitutional rights issues posed by individual mandates to purchase private plans.    Overall, a single-payer system will significantly simplify revenue collection and benefit payouts to a single agency.[40] Countries with single-payer systems experience significant cost savings over their multipayer counterparts through streamlining of billing and insurance procedures, creation of a more equitable and predictable spread of risk throughout the entire populace, and leveraging of bargaining power to control costs.[40]