Is now the time for single payer?


With the news that nearly 6 million Americans have lost their employer-sponsored health due to COVID, it is finally time to ask ourselves: is the “American Model” of health care working?

The “American Model” is a system of fragmentation: one in which changing jobs can mean lapses in insurance, moving to a new state can mean losing Medicaid eligibility, and getting a raise can mean financial ruin when you no longer qualify for subsidies. It is a system of waste: waste in administrative costs, waste in doctors’ time spent battling with insurers, and waste in the inability and unwillingness of insurers and hospitals to negotiate fair prices for their patients. And finally, it is a system that creates insecurity: insecurity in that a sudden illness or a surprise bill or a global pandemic has the potential to sideline a loved one, a family, or even the entire economy of a nation.

Even prior to the pandemic, the average American family spent nearly 1/6th of their income on health care, and medical debt was the number one cause of bankruptcy. This is not the prescription for a healthy economy; it is a risk factor for total collapse. And now we are seeing how vulnerable our economy is in the face of COVID; at a time when we must rely on our health care system to conquer a global health threat, that same system is becoming our biggest economic liability.

How can we ensure that our health care system endures the pandemic? And how do we guarantee that we emerge from this pandemic stronger and healthier than before? The answer is quite simple: through universal, publicly-funded health care for all. We need a system that administers health care equitably and cost-effectively to every citizen who needs it. And the private insurance industry is incapable of rising to the task.

The most obvious shortcoming of the private insurance industry is that it leaves millions of Americans uninsured. And too often, those who are insured are left with high deductibles and exorbitant costs in drug prices, co-pays, and other out-of-pocket expenses. And when COVID hits, individuals who are under- and uninsured delay seeking care, have higher rates of transmission, worse outcomes, and, of course, more expensive medical bills.

Furthermore, cost-sharing between private insurers, employers, and employees is unsustainable at a time when the economy is maximally strained. When purse strings are tight, many businesses choose to stop offering health benefits to their employees, while others are forced to let employees go. And in the aftermath, private insurers can inflate premiums in an effort to make up for loss of revenue, creating additional barriers to economic recovery.

Eventually, if and when the economy begins to recover, there will be huge swathes of people competing for a relatively small number of jobs. Prospective employees will have less bargaining power over health benefits, creating an even larger pool of individuals left out of the employer-based health care system.

Single payer is the solution. And the time for it is now.

A single-payer system would guarantee health care coverage immediately to every American. So whether a loved one gets sick from COVID, has a heart attack, or gets in a car accident, she will receive the care she needs without it causing financial hardship.

A single-payer system will eliminate employer health insurance contributions. This will provide huge relief to hundreds of thousands of struggling small businesses across the country. The money saved can go towards paying their employees a living wage or hiring new workers, which will help get our economy back on track.

A single-payer system will relieve the burden of finding health insurance from individuals. Freelancers and gig, self-employed, and per diem workers can pursue employment without having to worry about providing health coverage for their families. And with families relieved of the insecurities created by surprise medical bills and massive out-of-pocket costs, they will be more likely to contribute to our consumer-driven economy.

COVID has absolutely quelled consumerism; single payer can help to bring it back.

Still not convinced? Why don’t we turn to those that know the system best? An overwhelming majority of doctors, nurses, and hospital administrators support single-payer health care. Maybe it’s time we started listening. The very future of our country may hang in the balance.

Toby Terwilliger is an internal medicine-pediatric resident.

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