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If USC is ready for single payer, it’s time!

September 21, 2021

Summary: The University of Southern California medical school is often regarded as high class. But at least two of its current top leaders share health justice goals, and endorse single payer. The tide of support is turning!

Steve Shapiro brings a big-picture approach to medicine at USC
USC News
September 14, 2021
By Leigh Hopper

Steve Shapiro takes the macro view of medicine. This spring, he became the first senior vice president for health affairs at USC, where he will oversee — and build bridges between — clinical operations at Keck Medicine of USC and research and medical training at the Keck School of Medicine of USC.

Question: You’ve said that L.A. traffic will give you more time for audiobooks. Any recommendations, audio or otherwise?

S. Shapiro: I’ve just finished a couple of books. One was called Broken, Bankrupt and Dying by our chief medical officer at LAC+USC, Brad Spellberg. It’s the best argument I’ve heard for a single-payer system, as well as explaining the nuances of what single-payer means. It’s really impressive.

Broken, Bankrupt, and Dying
By Brad Spellberg (chief medical officer at LAC+USC)

I believe we should move forward with a universal, single-payer, national insurance plan, with no deductible or coinsurance, but with copays for speciality care and prescription drugs, funded by central collected taxes that everyone pays, but while still giving the individual a choice about whether they want to use the public insurance or buy their own private insurance. The resolution to the seeming paradox between a single-payer plan and offering choices is to give government-sponsored insurance to all residents, but also allow and encourage a thriving private insurance market that people can choose to purchase into if they would like. Let the public plan and private markets compete. Give people options.

I think this collective ideal makes the most sense. I think it will offer the best coverage at the best price, and will help reform healthcare delivery to eliminate waste and improve outcomes. I also think it is the most politically palatable, minimizing triggering opposition by including aspects that should appeal to people on both sides of the aisle.

But you know what? At this point, I’ll accept almost any universal system that can muster the political and social support behind it to get it done. I have no use for a philosophically optimal system that can never be implemented. I want something that can get done. So I’m keeping an open mind while advocating for what I think is best, and I’d encourage you to do that too.

Comment by: Don McCanne

For those of us on the West Coast, USC School of Medicine has the reputation, perhaps unfairly, of being the medical school with Rolls Royces in the doctors’ parking lot. For those who might doubt the social mission of USC medical school, these leaders at USC have provided very reassuring comments that show that they share health justice goals with the rest of us.

This book by Brad Spellberg describes many of the intolerable deficiencies and injustices of the current US healthcare system while proposing many corrections that must take place. Though there will be some debate over the specifics, the general approach of establishing a national health insurance program seems to have reached the point where there should be broad public acceptance. At least we now have reassurance that the institutions of the health professions are moving into alignment on the issues. Let’s all move in together and get it done.


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