Single Payer 20/20 Vision: Advantages & Obstacles

February 19, 2022

Summary: Today we summarize what single payer offers, and the challenges to achieving it, using the arbitrary framework of 20-item lists. (With President’s Day on Monday, perhaps Lincoln’s “Four score …” sent a subliminal message.) The incredible advantages justify continued struggle to overcome the daunting obstacles.

Comment by: Jim Kahn

Advantages

1. Everyone has high quality health insurance, with broad benefits. Forever.
2. You never need to choose or change insurance. 
3. Health coverage is highly equitable: everyone has the same insurance.
4. You can see any doctor or other licensed provider (eg therapist).
5. Physical and mental health are equally well-covered.
6. Dental, vision, and hearing are covered.
7. Long-term care is covered.
8. No more financial barriers to care: deductibles are gone, with no or minimal copays.
9. No more out-of-network financial penalties for patients.
10. No more bankruptcies due to medical bills.
11. Wasteful insurance paperwork disappears, leaving more money for medical care.
12. Insurer profits disappear, leaving more money for medical care.
13. Sky-high drug prices disappear, leaving more money for medical care.
14. The doctor-patient relationship is paramount.
15. Your doctor has no financial incentives to minimize care.
16. There are no health insurers to interfere with your care.
17. The electronic health record is stripped of billing complexity, so it’s easy to use and focused on clinical care.
18. The US treats healthcare as a public good, not a private commodity.
19. People in the US are proud of our excellent insurance and healthcare.
20. Full access to care reduces deaths by 100,000 per year.

Obstacles

1. Insurers will lose their healthcare business and profits.
2. Many pharmaceutical companies will lose sky-high profits.
3. Some large hospitals and provider systems will lose market power and profits.
4. Doctors worry that they’ll lose income (they won’t, and most will make more).
5. Some high-paid specialist physicians may earn less.
6. Insurers make huge donations to politicians and lobby (including against single payer).
7. Pharmaceutical companies make huge donations to politicians and lobby …
8. The American Medical Association makes huge political donations and lobbies …
9. Hospitals make huge political donations and lobby …
10. The massive healthcare financing enterprise (which consumes 3% of our national income) will need to reorganize, shrink, and shift its resources to clinical care.
11. The even more massive healthcare industry (nearly 1/5 of our economy) will need to transform its values system – from profit maximization to universal care access.
12. People like their doctors, and don’t realize that under single payer they can keep that doctor.
13. People worry about losing what they have with their current insurance.
14. People don’t know how well health insurance works in other wealthy countries.
15. Health insurers run a huge ongoing public relations campaign to extol the wonders of private insurance.
16. Health insurers promote “choice” – but that means choice of insurance, not doctor.
17. The health system is so complex it’s nearly impossible to understand and explain.
18. Opponents of single payer spread misinformation about it.
19. The myth of the healthcare market persists, despite being discredited repeatedly.
20. People often have trouble remembering all the ways that our system fails us daily, and how single payer would fix those problems. When they do understand, they see huge barriers to change. They just hope that they’ll be ok. Single payer seems out of reach.

The advantages of single payer are formidable, and so are the obstacles. Working in our favor is majority popular support for the idea. Achieving single payer would be transformative, both in the health care it provides and the triumph of community and democracy over profit and rule by the wealthy few.