What is Single Payer and Why Should Emergency Physicians Care?

By Dave Dvorak, M.D., M.P.H.
Minnesota / ACEP Newsletter, Dec. 19, 2014

As emergency physicians, we have chosen to work in a setting that treats all patients, regardless of their ability to pay. We deliver more uncompensated care than any other specialty. Whether you see this as honorable or unfair, it is emblematic of a long broken system.

Yes, the Affordable Care Act has gotten more Americans insurance coverage — but what kind of coverage?  Increasingly, ultra-high deductibles and copays are making patients reluctant to seek care when they need it — and vulnerable to financial ruin when they do.

America spends plenty on health care — twice per-capita as other industrialized nations — but with staggering inefficiency. Administrative overhead devours 31% of our health spending.  It’s our health insurance premiums that pay for those catchy HMO commercials and billboards, marketing departments, underwriters, lobbyists, eight-figure insurance executive salaries, and handsome investor profits. Has any of this ever helped you care for a patient?  

What if we redirected those wasted health care dollars into actual health care, while ensuring that all citizens have access to quality care? This is the case for single payer health reform.

The power of single payer is its efficiency. It replaces the dizzying labyrinth of private insurance plans with a single, unified public financing stream. Yet it maintains the private practice of medicine, encouraging market-based competition where it matters — among providers. Single payer streamlines payment for health services and products by establishing uniform, transparent pricing. It replaces the costly, cumbersome practice of itemized hospital billing with global annual budgeting, removing layers of hospital administrators and bloated billing departments. 

Most importantly, single payer guarantees quality coverage to all, removing crippling out-of-pocket liabilities. The win-win result is that emergency physicians are compensated fairly for every patient we treat, while our patients no longer fear crushing medical bills and visits by debt collectors.

The ACA’s State Innovation Waiver will allow individual states, beginning in 2017, to apply for federal waivers to implement their own innovative health systems, provided they can cover at least as many residents without costing more. This is a huge opportunity for Minnesota to lead.

The Lewin Group recently studied the economic feasibility of a Minnesota single payer system. It found that such a system could provide comprehensive health and dental coverage to every Minnesotan while saving the state an extraordinary $65 billion in health spending over 10 years. The median-income Minnesota family would save an average of $3,512 per year on health care. Importantly, the savings came primarily from reduction of administrative waste; provider compensation remained unchanged.

Because I believe single payer is the most sensible, equitable and sustainable way forward, I’m a member of the Minnesota chapter of Physicians for a National Health Program, which advocates for universal coverage through single payer reform. I’m in good company — currently, over 1,000 fellow Minnesota physicians and health professionals have signed the resolution in support of single payer. I encourage all Minnesota emergency physicians to learn more about single payer and consider supporting the movement at

Dr. Dvorak is an emergency physician who has practiced with EPPA for 20 years. This article appeared in the "Member Point of View" section of the newsletter.