Medical students advocate for single-payer health care

Medical students begin their training with optimism and a desire to help others. If we didn’t, there would be no point in subjecting ourselves to such grueling training. As students, we have a unique view of the health care system: as outsiders open to new ideas and not jaded by years

Michael Danziger, of New York City, and Kelsey Sklar, of Westchester, are medical students at SUNY Downstate College of Medicine. Alec Feuerbach, of Colorado, is a medical student at the Icahn School of Medicine at Mount Sinai.

of exposure, and as insiders who will soon practice within the system and want the best for our future patients. With this perspective, we, and many other medical students, advocate for a single-payer health care system — one in which the government, rather than private insurance companies, is solely responsible for reimbursement — both in New York with the New York Health Act and for the country as a whole.

The facts are simple: the United States spends more per capita on health care than any other country in the world and ranks last among peer nations in quality, efficiency and access. Reform is needed, but not all strategies for universal coverage are equal.

Organizations such as the Center for American Progress have devised proposals with names like “Medicare Extra for All” that aim to provide “affordable” universal coverage while maintaining private insurance relationships. Such plans requiring private insurers will not

work.

The Affordable Care Act was an opportunity to demonstrate workable publicprivate insurance. While it extended care to millions, the amount and quality of the coverage has been variable. Given that one in five Americans with insurance has significant medical debt, the ideals of the ACA have not come to fruition. Moreover, private insurance companies consistently prove unwilling to fully participate in such a system; Aetna, for example, pulled out of ACA exchanges after a federal judge rejected a merger with Humana.

Ultimately, any universal coverage plan depending on public-private cooperation is a Rube Goldberg machine of schemes by which private insurers are paid using public funds. Single-payer, by contrast, is simpler and more efficient for providers and patients alike. As such, we advocate for a single-payer system specifically and against Potemkin universal plans.

In a single-payer system, less time and fewer resources are devoted to billing, giving physicians greater opportunity to provide care. Though study after study have shown that a single-payer system would be less costly in the long-term, the economics of single-payer are still debated. While some of this debate stems from the difficulty of predicting the total impact of such a broad policy on a complex economy, it is curious that few other policies are subject to as much granular dissection as single-payer. There may have been some pushback to Trump’s commitment of $750 billion to the defense budget, for example, but it was not met with the same economic hand-wringing that any proposal for single-payer has received.

Of course, economic evaluations of policies are important, but endless interrogation of such a well-studied system is costing lives. In light of the numerous studies, recommendations for perpetual discussion do nothing but enable our embarrassing status quo to continue. No more patients should die as a result of stakeholders dragging their heels.

Nevertheless, as medical students, our advocacy for single-payer stems not from an economic position, but from concern for patients. Single-payer ensures that medical need, not the ability to pay, is the basis of treatment. While no proposed legislation is perfect, enacting singlepayer is the first step towards reforming our dysfunctional system. Moreover, the system will evolve and adapt to the needs of patients and providers. As future physicians, it is incumbent on us to advocate for the system that allows us to provide the best quality care to the greatest number of people.