Advocacy for a Single-Payer System

by Jen L’Insalata

Advocacy is an important component of the role of counselors. By definition, advocacy is the act of working toward improving the welfare of their clients by bringing awareness to issues within the mental health filed. Over the years the American Counseling Association had advocated for the advancement and strengthening of the counseling profession. Often times counselors advocate for their role within a particular context or for the overall profession (Erford, 2018). Other times counselors advocate for a specific cause related to their counseling domain.

The concept of healthcare reform has been around for several years and has become a focal topic in many recent political campaigns. Healthcare reform impacts the mental health community as changes to healthcare policy have the potential to shift who can access what types of mental healthcare. Serious mental illness including chronic psychosis, depression, anxiety, and substance use disorders presently account for the majority of disability claims worldwide. The cost of serious mental health care has risen exponentially and when left untreated leads to premature morality rates (Kilbourne, Keyser, & Pincus, 2010).

Under our present system, the cost of treating individuals without adequate healthcare is shifted to the general population by means of fees, service costs, and point of service charges. In 1991, it was estimated that the burden of healthcare for underinsured populations was more than $21 billion (Daschle, Cohen, & Rice, 1993). Multi-payer insurance providers form a patchwork system consisting of in network and out of network services which may shift depending on a client’s coverage package.

As a result, there is an increase in administrative costs allocated to managing the paperwork required to navigate the current healthcare system. Misallocation of funds has led to research in tertiary healthcare procedures while less glamorous areas of healthcare have been deemphasized. Additional aspects of a fee-for-services system has complicated immediate access to care and benefitted some organizations with internal referral systems where unnecessary services are provided (Daschle, Cohen, & Rice, 1993).

This has created what Kilbourne, Keyser, & Pincus (2010) call a cook-book method of treatment where organizations operate within silos rather than integrative treatment through collaborative efforts. Fee-for-service is often evaluated on 3 major domains; structure, process, and outcome with the rationale that mental healthcare resources and policies inform process used by clinicians. In practice, evaluation of fee-for-service systems have emphasized the characteristics of the treatment setting including infrastructure and staffing over quality of care.

The art of counseling relies heavily on the therapeutic relationship through the emphasis of person-centered approach. The core of person-centered counseling emphasizes unconditional positive regard, congruence, and accurate empathy that empowers a client to examine patterns of behavior and reflect on opportunities for personal growth and well-being (Cormeier, & Hackney, 2012). The quality of care provided becomes difficult to measure under a fee-for-service medical model where a client-therapist fit should take precidence.

Under a single payer system, a single publicly financed insurance fund would cover all Americans evenly while ensuring access to comprehensive mental healthcare despite income, employment, or that ability to cover out of pocket expenses (Hsiao, Kinght, Kappel, & Done, 2011). Several single-payer proposals exist that illustrate more subtle nuances such as funding at the federal or state level (Daschle, Cohen, & Rice, 1993) and implementation strategy. Programs similar to Medicaid/Medicare offer flexibility in coverage to include medical, psychological, and homeopathic treatments. This would allow flexibility in treatment approach for counselor to tailor their therapeutic methodology to fit each client on an individual level; emphasizing a client-centered, counselor-client fit.

Presently, there are several barriers preventing the implementation of a single-payer system. Advocacy against healthcare reform comes heavily from the for-profit insurance industry. Accessing information surrounding policy on healthcare reform is limited and often difficult to understand. I personally struggled to find free resources that outlined policy in an easy to digest manner and much of my understanding has come from previously reading Senate Bill 1129 introduced to the 116th Congress this past May. I feel it is safe to assume that many counselors and mental health practitioners may not fully understand the implementation of healthcare reform on their personal practices and livelihoods. Advocacy serves as an avenue to break down complex congressional legislature into digestible articles that can be read and understood easily.


Cormier, S., & Hackney, H. (2012). Counseling Strategies and Interventions (8th ed.). Pearson. ISBN 10: 0-13-707018-7

Daschle, T. A., Cohen, R. J., & Rice, C. L. (1993). Health-care reform: Single-payer models. American Psychologist, 48(3), 265–269.

Erford, B. T. (2018). Orientation to the counseling profession: Advocacy, ethics, and essential professional foundations (3rd ed.). New York, NY: Pearson.

Hsiao, W.C., Kinght, A.G., Kappel, S., & Done, N., (2011). What Other States Can Learn From Vermont’s Bold Experiment: Embracing A Single-Payer Health Care Financing System. Health Affairs. Retrieved from

Kilbourne, A. M., Keyser, D., & Pincus, H. A. (2010). Challenges and Opportunities in Measuring the Quality of Mental Health Care. The Canadian Journal of Psychiatry, 55(9), 549–557.

Sanders, Baldwin, Blumenthal, Booker, Gillebrand, Harris, Leahy, Markey, Merkley, Schats, Udall, Warren, Whitehouse, Hirono, & Heinrich. (2019) Senate Bill 1129. 116th Congress. 1st Session. Medicare for All Act of 2019. Retrieved from


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