Healthcare provision in the U.S. is complicated with a long turbulent history of successes and failures of a robust system that has failed to live to its expectations. Despite spending almost double as much per capita for healthcare as compared to other developed countries, the US health metrics are among the lowest when compared to other peer nations. The Trump administration has hinted at repealing the Affordable Care Act (ACA) but it is unclear what system would replace it and whether it will be better or worse. Therefore, policymakers and interest groups have been mooting the idea of adopting a single-payer system to ensure that all Americans are insured regardless of income or status in society. Proponents of this new system call it “Medicare for All”, and it has been termed as the easiest route to universal health coverage in the US. However, like any other proposal, the single-payer system has been criticized with opponents citing numerous challenges that it would present to care providers and other stakeholders. This policy position paper discusses the single-payer system by highlighting its evolution, major policymakers involved, nursing role in it, and the associated ethical challenges. Single-Payer System – An Overview A single-payer is system is a form of universal healthcare whereby services are financed through taxes to cover all costs associated with healthcare for all citizens (Liu & Brook, 2017). The costs are paid by one entity, such as the government, hence the term “single-payer”. This system will ensure that everyone accesses healthcare services regardless of class, race, income status, or any other demographic. Currently, despite the introduction of the ACA in the American healthcare system, many people are either uninsured or underinsured. Healthcare in the US is extremely expensive and when people have to pay from their pockets, chances of becoming bankrupt are high. Ironically, despite being the largest spender in healthcare, the country scores poorly on major health indicators. For instance, the US has “12.2 maternal mortality deaths per 100,000 compared to 4.8 in Canada which, like other developed nations, has a single-payer health care program” (Martin, 2017, p. 182). Therefore, there is a need to look for better alternatives to ensure that Americans receive quality care services commensurate with the huge amounts of money spent on the same for better health outcomes and quality of life. The history of a single-payer system in the US is long and it dates back to the times of President Franklin Roosevelt in the 1930s when he proposed the adoption of a universal healthcare plan as he devised the Social Security scheme (PNHP, 2019a). President Truman also attempted to introduce such a program but in 1953, Congress defeated his efforts. President Lyndon Johnson also had a similar proposal but the opposition could not allow its implementation. President Barack Obama openly supported a single-payer system, but his efforts did not bear fruits and the closest he came was the adoption of Obamacare policies (PNHP, 2019a). When the ACA was passed in 2010, it was assumed that it would address some of the major problems facing care provision to Americans. However, as mentioned earlier, millions of peo