Proposal for Single Payer

The following abstract is from the Proposal of the Physicians' Working Group for Single-Payer National Health Insurance. The article first appeared in the Journal of the American Medical Association(JAMA) on August 13th, 2003. You can read the full text of the article here:

Proposal of the Physicians' Working Group for Single-Payer National Health Insurance

The article makes the case that the United States must pursue a single payer system for the benefit of not only the patient, but also for the physician, the national economy, and especially the uninsured. While it represents only one opinion on how to fix our broken system, it is a testament to the well researched and well reasoned thinking that has been going on in health policy for years.

With that in mind, it is my hope that in reading this proposal, single payer supporters will gain a deeper understanding of the issues at hand, while critics, if nothing else will come away with a greater appreciation of the type of thought and insight requisite in forming alternative proposals.

**Co-author Steffie Woolhandler, MD, MPH (Department of Medicine, Cambridge Hospital/Harvard Medical School, Cambridge, Mass) is one of our guest lectures for the March 23rd event: "Our System, Our Future: Covering the Uninsured and Prospects for Healthcare Reform"**


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The Physicians' Working Group for Single-Payer National Health Insurance^*

JAMA. 2003;290:798-805.

"The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet more than 41 million Americans have no health insurance. Many more are underinsured. Confronted by the rising costs and capabilities of modern medicine, other nations have chosen national health insurance (NHI). The United States alone treats health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In this market-driven system, insurers and providers compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs that, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar. We endorse a fundamental change in US health care—the creation of an NHI program. Such a program, which in essence would be an expanded and improved version of traditional Medicare, would cover every American for all necessary medical care. An NHI program would save at least $200 billion annually (more than enough to cover all of the uninsured) by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Physicians and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules, often designed to avoid payment. National health insurance would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run. An NHI program is the only affordable option for universal, comprehensive coverage."