Single-Payer Health Care: “The Next Logical Step”

By Chandak Ghosh, M.D., M.P.H.
EyeNet, Letters, October 2018

Reading “Single-Payer Health Care: Of Canada and California” (Current Perspective, August), I was struck by its alarmist tone.

Single-payer health care is suddenly looking attractive to Americans because of the failure of for-profit, private insurance-centered health care. Before the Affordable Care Act (ACA) was implemented in 2010, insurance prices were increasing exponentially; 15% (and quickly rising) of Americans were uninsured; medical bills caused most bankruptcies; quality remained the worst among comparable countries; and health care was reaching 20% of the federal budget and gross domestic product.1

With the ACA, we attempted a market-based approach. It stabilized prices, but its complexity and continued reliance on private insurance has doomed it. The Republican Party is dismantling ACA without any workable replacement.2

The type of single-payer gaining most support is an improved “Medicare for all.” Yes, taxes will go up, but Americans will no longer pay private insurance premiums, deductibles, co-pays, and co-insurance. Drug prices will fall.1 People will pay about one-third less for health care overall.1 Doctors and hospitals will enjoy a precipitous drop in administrative costs and malpractice insurance prices.2 Medical students will pay much less for schooling and avoid the crush of student loans. Best of all, every American will gain access to a higher quality of care, improving outcomes while decreasing costs.

Private insurance is just a middleman that moves money from the patient to the provider. Its real point is to make profits for shareholders, yet we are paying 30 cents of every health care dollar for administrative costs and insurance company profits, instead of improving health.1

The single-payer form of universal coverage will come to the United States, as it remains the cheapest way to cover everyone. We see it succeeding in nearly every developed country of the world, and in the United States as Medicare, the government’s most beloved program. Expanding Medicare to cover everyone is the next logical step.


1. Gaffney A. Journal of Policy Analysis and Management. 2018;37:188-195.

2. Woolhandler S, Himmelstein D. Ann Intern Med. 2017;166(8):587-588.