“Our current system of multiple payers is supposed to foster competition, which in turn is supposed to make health care more affordable, more accessible and have higher quality,” writes Dartmouth’s H. Gilbert Welch, M.D., in a CNN opinion piece. “How could a single payer ever improve on that?”

Easily, writes Welch, a professor of medicine at the Geisel School of Medicine and atThe Dartmouth Institute for Health Policy & Clinical Practice.

“First, multiple payers multiply the complexity for patients,” he wrote for CNN. “Sure there are many choices, but patients may not understand the tradeoffs involved—often because they have incomplete information (Exactly who is in-network anyway?). While there may be some who enjoy all these choices, they are overwhelming for many.

“And for those who might be eligible for financial assistance, there is another set of hurdles in simply determining their eligibility (What will your income be?). These hassle factors loom particularly large for those who have little immediate motivation to care about insurance—the young—the very group we’d most like to have it.

“With a single payer these complexities disappear: Everybody is in, nobody is out.”