Moral injury is often confused with physician burnout, but Dr. Singh says there's an important distinction.

If the thing that's getting you so angry at the system is not being able to give people the care they need, that's very different from, I just don't have time to sleep, I don't have time to eat, I don't have time to think.

And I'm just feeling like my patients are making me crazy because they just keep asking more of me than I can physically give.

That's a very, very different thing.

They can overlap.

But the important thing to me about moral distress and moral injury is it's not about the individual health care professional.

It's not about the nurse.

And yet, she says, it's not the suffering inherent in medicine that troubles her the most.

And have you had this feeling in your own practice as it happened for you?

Absolutely, every day.

You know, and I think there's like an insidious part of it.

Like when I was a new, fresh GYN oncologist, We used to work so hard to the second that somebody had a cancer diagnosis, like get them to treatment.

And the concept was there was research, not in GYN-ONC at the time, although there has been since, but at the time it was clear from breast cancer care and colon cancer care that the time from diagnosis to treatment had impact on cure and survival.

Yes, that makes sense.

The shorter that time is, the better.

What's in the survey that you used to measure moral distress or moral injury? What's in it?

Dr. Singh, what models are out there that you think the United States could follow and maybe not a carbon copy, but what are some of the models that you think are successful that we could take some lessons from?

You know, I'm going to be straight with you, Scott.

I think there's a lot of healthcare systems out there.

The Canada does it one way, the UK does it another, Japan, Australia, all these countries.

I honestly think we will do an American system, if that makes sense.

And this is the reason.

We have great medical schools.

And I'm

If we imagine that right now

somewhere between 30 and 45 cents of every single healthcare dollar is wasted on something that is not healthcare, what would it be wasted on? Well, a big part of it is profit for those middlemen, those insurance companies, those pharmacy benefit managers, those people who stand between us and our healthcare.

There's the administration that comes from, well, if it's Blue Cross Blue Shield, this is what we do.

And if it's United, this is what we do.

And, well, you know, I'm not in my home state, so what does it mean when I'm here in Michigan instead of Washington, D.C., et cetera? So we eliminate all that waste.

And it's very clear the Congressional Budget Office, nonpartisan organizations have done the research.

We have the money in our system right now to not only cover everybody, but give everybody vision care, right? How do we decide eyes aren't part of vision? Basic health care to give everybody dental.

From where you sit, are you hearing from your PNHP member physicians that there is a surge of support for policies like Medicare for All this year?