“We have pledged to ‘do no harm’ in our pursuit of medicine; however, our current for-profit insurance system in the United States routinely harms patients.”
At the UC Berkeley-UCSF Joint Medical Program (JMP), our instructors implore us to examine the social and structural determinants of health. Many of us at the JMP have recently gathered to support the Medicare for All National Week of Action, as we believe that one of the greatest strides our country could make towards health justice and equity would be to guarantee every person in the United States access to high-quality healthcare via a single-payer funding system.
We have pledged to ‘do no harm’ in our pursuit of medicine; however, our current for-profit insurance system in the United States routinely harms patients. It consistently produces far poorer health outcomes than any other industrialized country. Physicians and other providers often deny patients life-saving care because they lack the proper insurance, causing tens of thousands of preventable deaths every year.
Indeed, the United States routinely ranks last among developed nations in terms of health equity – quantified as the percentage of patients who did not get recommended tests, treatments, or follow up care due to cost. Alarmingly, life expectancy increases linearly by income level in the United States and can be mapped to geographic areas. Many Americans skip treatment every day due to unaffordable out-of-pocket costs. An estimated one million individuals experience medical bankruptcy every year.
Even after the passage of the Affordable Care Act, over 25 million Americans remain uninsured. Furthermore, nearly a third of Americans are considered ‘under-insured’; around 80% of medical bankruptcies occur in patients who were already covered. This current system is clearly inadequate – when people resort to crowdfunding their medical bills, something needs to change.
These health and economic injustices exacerbate the inequalities already experienced along racial, ethnic, and immigration status. A single-payer system would not solve these health disparities or eliminate the structural racism embedded in our health system. However, it would ensure that healthcare is considered a universal necessity and not a commodity reserved for the few who can afford it.
A single-payer system promotes equity by replacing all out-of-pocket expenses (premiums, payroll deductions, deductibles, co-pays) with a progressive tax on corporations and the highest income bracket. The waste associated with private insurers has been estimated at $400 billion per year; single-payer would increase efficiency by cutting 80% of administrative costs and diverting these currently squandered resources toward patient care. Having a single payer forces hugely profitable pharmaceutical companies to negotiate and cut prices. These savings and the additional taxes would more than provide for universal coverage. In fact, study after study show that a single-payer system would save the U.S. money, on the order of trillions of dollars over the next decade.
Still, all these economic arguments mean little until we recognize healthcare as a human right. Equity and efficiency in the American health-care system have fallen to unacceptable levels. We do not want to practice medicine in a system that fails to meet the health needs of our population, especially its most vulnerable. This dire situation requires a bold solution: implementing a single-payer system is an essential step towards providing our patients the care they deserve.