by Jason Tilipman
5/13/2016

While Republicans are scrambling to convince their voter base that they will “repeal and replace” the Affordable Care Act (ACA), doctors are backing Bernie Sanders in his call for single-payer healthcare.  Last Thursday, 2000 physicians published a document in the American Journal of Public Health titled “A Physician’s Proposal for Single-Payer Health Care Reform.”  The proposal praises the ACA for its successes while acknowledging that it falls short by leaving millions uninsured and doing nothing to reduce the vast administrative costs in our complex healthcare system.

According to the report, “Coverage would be extended to all age groups, and expanded to include prescription medications and long term care. Payment mechanisms would be structured to improve efficiency and assure prompt reimbursement, while reducing bureaucracy and cost shifting. Health planning would be enhanced to improve the availability of resources and minimize wasteful duplication. Finally, investor-owned facilities would be phased out.”

From the standpoint of providing coverage, the Affordable Care Act has been an enormous success.  As of 2016, roughly 20 million Americans have obtained health insurance through state and federal insurance marketplaces, and if the Supreme Court had not struck down mandatory Medicaid expansion that number would be even higher.

Still, the law is not perfect — the Congressional Budget office estimates that 28 million Americans will be left uninsured in the next decade.  For those that believe healthcare is a fundamental right, this is an unacceptable outcome.  Additionally, coverage is still dependent on private insurers whose primary motivation is to earn a profit.  UnitedHealthcare’s upcoming exit from a handful of insurance exchanges is a harbinger of actions that insurers will have to take as they face increasing losses.

The Physician’s Proposal seeks to overcome this obstacle by implementing a single-payer, Medicare-for-all model.  Under this structure, one centralized entity would provide health insurance to all Americans.  Patients would have a choice of any doctor and hospital, no longer bound to their insurer’s “network.”  Bureaucracy and administrative costs would be drastically reduced.  Employers would no longer be responsible for providing insurance, which means that roughly 50% of Americans no longer have to be dependent on having a job in order to gain insurance.   Crucially, a nationalized insurer could use their leverage to negotiate for lower prices for drugs and medical services.

After examining the potential results, we have to ask ourselves why the United States has not made strides towards a Medicare-for-all system.  Other countries that utilize a single-payer model spend far less on healthcare and have better health outcomes, including reduced prevalence of chronic diseases and lower mortality rates.  Of course, the answer is because of the entrenched medical-industrial complex and excess profiteering.

The ACA has provided access to care for millions of Americans, but at its core it is fundamentally flawed.  Incremental provisions will not contain costs in a meaningful way, and until there exists a sole provider of insurance there will continue to be millions of Americans without care.  58% of Americans support Medicare-for-all so it is time for our government to seriously discuss moving to single-payer.

Jason is a Master of Public Policy candidate at the Goldman School of Public Policy and an editor at Policy Matters Journal. Before coming to Goldman, Jason was a researcher at the Stanford School of Medicine.