Is a Single-Payer Health Insurance Program Feasible?

Two letters: Alan Meyers, M.D., and Jim Recht, M.D.
The New York Times, Letters, Jan. 21, 2016

To the Editor:

Re “Health Reform Realities” (column, Jan. 18):

I’m glad to see that Paul Krugman acknowledges that “if we could start from scratch, many, perhaps most, health economists would recommend single-payer, a Medicare-type program covering everyone.” His argument that we should not work for it now is unconvincing.

Just because private insurers are powerful doesn’t mean a concerted national campaign can’t overcome their well-funded opposition. Already a majority of the general public (58 percent in a recent Kaiser poll) supports single-payer. Cost will never be controlled until we do away with the bloated administrative expenses of our hopelessly complex financing arrangements and for-profit medicine.

And while the Affordable Care Act has indeed been a great help for many seeking health insurance, it has left over one-fourth of Americans ages 18 to 64 with problems paying their medical bills. As you have reported, that can be the case even for those with insurance (“Medical Debt Often Crushing Even for Insured,” The Upshot, Jan. 5).

We can do better, as every other developed nation has demonstrated.


Dr. Alan Meyers resides in Boston. He is a professor of pediatrics at Boston University School of Medicine and a founding member of Physicians for a National Health Program.

To the Editor:

Paul Krugman argues that perhaps the “most important” reason not to pursue single-payer health care financing is that it “would impose a lot of disruption on tens of millions of families who currently have good coverage through their employers.”

As a physician who happens also to be an employee of a large Boston-area human services agency, I can tell you from personal experience, as well as from the (frequently desperate) experiences of my patients, that “good” is not how any of us would describe our coverage.

Premiums are jaw-droppingly high (and projected to increase anywhere from 6.8 to 16.5 percent this year); high-deductible and other “Swiss cheese” insurance policies have become the norm, resulting in increasing out-of-pocket co-pays and deductibles; and obstacles to care, from arbitrary “prior authorization” requirements to restricted panels, regularly prevent people from receiving the care they need. Along with so many of my patients and colleagues, I am convinced that single-payer is right for us, right now.


Dr. Jim Recht resides in Cambridge, Mass. He is an an assistant professor of psychiatry at Harvard Medical School.