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Resources For A Defense of Single Payer Universal Health Insurance PDF Print E-mail
Tuesday, 14 July 2009 09:54

The following is reprinted from Physicians For A National Health Program:

Single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.

Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 45.7 million completely uninsured and millions more inadequately covered.

The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead,

underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $350 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do.

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.

The links below will lead you to more specific information on the details of single-payer:

Single-Payer Overviews


The Physicians Proposal for National Health Insurance

“Proposal of the Physicians’’ Working Group for Single-Payer National Health Insurance,” JAMA 290(6): Aug 30, 2003

Key Features of Single-Payer
A useful handout detailing the main features of single-payer.

Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act
A great overview of the need for and logic of a single-payer system. Perfect as an introductory handout.

Liberal Benefits, Conservative Spending
Another great introductory handout.

The case for eliminating the private health insurance industry
By Don McCanne, MD and Leonard Rodberg, PhD

Public Citizen's Response to the Citizens' Health Care Working Groups Interim Recommendations (En Español)
A great overview on the benefits of a single-payer system by Public Citizen.

Rep. Dennis Kucinich Tackles Health Care
Rep. Kucinich talks with Truthdig about the health care crisis in America.

Financing single-payer national health insurance: Myths and facts

Download PNHP's Brochure

Single Payer: Facts and Myths


Single Payer FAQ
A frequently-updated catalog of the most-asked questions about single-payer.

Myths as Barriers to Health Care Reform
A paper refuting many of the myths associated with single-payer.

“Mythbusters” by the Canadian Health Services Research Foundation
A series of brief papers debunking the common misconceptions about the Canadian health system.

“Moral Hazard:” The Myth of the Need for Rationing

Rasell, E “Cost Sharing in Health Insurance – A Reexamination,” New Eng J Med., 332(7) 1995

Roos, et al “Does Comprehensive Insurance Encourage Unnecessary Use?” Can. Med. Assoc. J 170(2) Jan. 20, 2004

Gladwell, M. “The Moral Hazard Myth,” New Yorker Aug. 29, 2005

Myths and Memes About Single-Payer Health Insurance in the United State: A Rebuttal to Conservative Claims

Geyman, John; International Journal of Health Services, Volume 35, Number 1, Pages 63–90, 2005

Health Economics and Financing


Introduction: How Much Would a Single-Payer System Cost?
A review of government and independent studies of the cost of single-payer system.

Administrative Waste Consumes 31 Percent of Health Spending

Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003

Administrative Costs in U.S. Hospitals are More Than Double Canada’s

Woolhandler, et al “Administrative Costs in U.S. Hosptials,” NEJM 329, Aug. 5, 1993

60 Percent of Health Spending is Already Publicly Financed, Enough to Cover Everyone

Woolhandler, et al. “Paying for National Health Insurance – And Not Getting It,” Health Affairs 21(4); July / Aug. 2002

A Proposal for Financing National Health Insurance

Rasell, Edith “An Equitable Way to Pay for Universal Coverage,” International Journal of Health Services. 29(1); 1999

"Liberal Benefits, Conservative Spending"
Grumbach, et al. JAMA, May 15, 1991, Vol. 265 No. 19

"Markets and Medical Care: The United States, 1993-2005"
Joseph White, Case Western Reserve University, The Milbank Quarterly, Volume 85, Number 3, 2007

"Single Payer—Fifty Players: Alternative Payers for Universal Health Insurance"
Thomas Bodenheimer, Health/PAC Bulletin, Fall 1992

Paying More, Getting Less: How much is the sick U.S. health care system costing you?
Joel A. Harrison, Dollars and Sense magazine, May/June 2008 issue

Canadian Health Insurance: Lessons for the United States
June 1991; General Accounting Office (ref no: T-HRD-91-35)

The Case Against For-Profit Care


Overview: The High Costs of For-Profit Care

Editorial by David Himmelstein, MD and Steffie Woolhandler, MD in the Canadian Medical Association Journal

For-Profit Hospitals Cost More and Have Higher Death Rates

Devereaux, PJ “Payments at For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J., Jun 2004; 170

Devereaux, PJ “Mortality Rates of For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J, May 2002; 166

For-Profit Hospitals Cost More and Have Higher Administration Expenses

Himmelstein, et al “Costs of Care and Admin. At For-Profit and Other Hospitals in the U.S.” NEJM 336, 1997

For-Profit HMOs Provide Worse Quality Care

Himmelstein, et al “Quality of Care at Investor-Owned vs. Not-for-Profit HMOs” JAMA 282(2); July 14, 1999

For-Profit Medicare Plans Cost 11 Percent More Than Traditional Medicare
MedPac Report, Jun 9, 2006

Quality and Malpractice


Introduction: Medical Malpractice, Health Care Quality and Health Care Reform (pdf)
A Forum Report by Gordon Schiff, MD

How Single-Payer Improves Health Care Quality (pdf)
A brief by PNHP (makes a great handout!)

A Better Quality Alternative: Single-Payer National Health Insurance

Schiff, et al “A Better Quality Alternative” JAMA, 272(10); Sept. 12 1994

Comprehensive Quality Improvement Requires Comprehensive Reform (pdf)

Schiff, et al “You Can’t Leap a Chasm in Two Jumps,” Public Health Reports 116, Sept / Oct 2001

The Failures of Other Reform Options


Individual Mandates (The Massachusetts Plan)

Consumer Directed Health Care and Health Savings Accounts

Tax Credits for Private Insurance

Why HSAs Won't Cure What Ails U.S. Health Care

Critique of Sen. Wyden's (OR) "Healthy Americans Act"

Comparison between Schwarzenegger Health Plan and Single Payer for California

State Single-Payer Bills


Issues for State Single-Payer Legislation
By Dr. Steffie Woolhandler

Key Features of Single-Payer
A useful handout to help recongnize state single-payer legislation

Health Spending By State Of Residence, 1991—2004
Health Affairs 26, no. 6 (2007): w651— w663

Arizona

California - SB810

Colorado

Illinois

Minnesota

International Health Systems


International Health Systems for Single Payer Advocates
By PNHP Executive Director Dr. Ida Hellander

International Resources on National Health Insurance
Compiled by Joel A. Harrison, Ph.D., MPH

Health Care Systems - Four Basic Models
An excerpt from T.R. Reid’s book on international health care, "We’re Number 37!"

Single-Payer Bibliography


A bibliography of single-payer studies and papers
 

Artwork by Nohad Nassif

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Think Progress
  • Nearly Half The Public Is ‘Very Uncomfortable’ With Phasing Out Social Security For Private Accounts

    A recently-released Wall Street Journal/NBC News poll surveyed Americans on a variety of issues, including their views on the country’s direction, their approval of the president’s handling of the economy, and what they think of Congress’ performance.

    One section of the poll asked respondents how they would feel about a candidate who ran based on several different policy platforms. Respondents then replied whether they were enthusiastic about the platform, comfortable with it, had reservations about it, were very uncomfortable with the position, if it made no difference, or they weren’t sure. The results were listed numerically responding to each category from left to right.

    The two issues that netted the highest “uncomfortable” rating from poll respondents were Bush’s economic policies and Social Security privatization. 39 percent of those polled responded that they’d be uncomfortable with voting for a candidate who supported the economic polices of former president George W. Bush. But the position that provoked the highest level of opposition was supporting “phasing out Social Security and instead [supporting] allowing workers to invest their Social Security contributions in the stock market,” with 49 percent of respondents saying the position made them “very uncomfortable“:

    poll7

    While the poll shows that only 21 percent of the public is “enthusiastic” or “comfortable” with slowly privatizing Social Security, there are a number of leading Republican officeholders who have endorsed the concept of doing so. Rep. Paul Ryan (R-WI), the “ranking member on the House Budget Committee,” has put together a road map for privatizing the program that is similar to President Bush’s failed 2005 plan. Sen. Jim DeMint (R-SC) has also indicated that he’d like to revive the Bush effort. Rep. Michele Bachmann (R-MN) has talked about the need to “wean” Americans off the program.

    Meanwhile, a number of leading Republicans running for office have also endorsed radical plans to privatize the program. Both Pennsylvania Republican senate candidate Pat Toomey and Rand Paul have endorsed at least partially privatizing Social Security. Nevada Republican senate candidate Sharon Angle has called for the program to be “phased out,” and Alaska Republican senate candidate Joe Miller has gone even further, declaring that the program is simply unconstitutional.

  • NM Corrections Secretary Refusing To Penalize Contract-Breaching Private Prison Company He Used To Work For

    joeThe escape of three detainees from a privately-run prison in Arizona last month “put the spotlight on…private prisons,” as critics of prison privatization pointed to the “lax oversight” of the private prison system as one reason the inmates were able to so easily break out of their facilities.

    Now, the New Mexico Independent (NMI) reports that neighboring state New Mexico is experiencing similar lax oversight as “the New Mexico Corrections Department has not collected penalties from two private prison operators despite repeated contract violations, costing the state potentially millions of dollars in uncollected fines.” The two prison operators in question, GEO Group, and Corrections Corporation of America (CCA), have been found to be understaffing the prisons they operate, not meeting contractual obligations.

    In an interview with NMI, New Mexico Corrections Secretary Joe Williams “acknowledged that the vacancy rates at the prisons GEO and CCA operate often are higher than their contracts allow,” but said he “decided against punishing the firms because the prisons they manage ‘are outstanding.’” He explained that the prisons’ contract doesn’t say that he “shall” fine the companies for violating the terms of the agreement, but rather that he “can”:

    The New Mexico Corrections Department has not collected penalties from two private prison operators despite repeated contract violations, costing the state potentially millions of dollars in uncollected fines, state officials have told The Independent. [...]

    Williams acknowledged that the vacancy rates at the prisons GEO and CCA operate often are higher than their contracts allow, but he decided against punishing the firms because the prisons they manage “are outstanding,” he said. “They are not having escapes; there are no substantial problems. If there were a problem I would be down there penalizing them,” he said. [...]

    “The contract does not say I shall do it. The contract says I can do it,” Williams told The Independent.

    In choosing not to penalize the GEO and CCA prisons for understaffing their facilities, Williams is far from an impartial arbiter. As his biography page on the New Mexico Corrections Department website boasts, in 1999, the “Geo Group, Inc. (formerly known as Wackenhut) hired Joe as the warden for the Lea County Correctional Facility, and charged him with turning around the troubled prison in Hobbs, New Mexico. The facility eventually became a flagship prison. Agreeing to serve as its warden proved to be the right move, both professionally and personally. In fact, Joe liked the city of Hobbs so much, he named his beloved basset hound Sir Hobbs.” It adds that Williams’ experience at GEO gave him “rare insight into the world of private corrections” and made him an “ideal candidate for the job he now holds.” The biography notes that the state’s incarceration system is “44 percent privatized, and leads the nation in prison privatization.”

    The Governor’s website notes that Williams is “the first private sector Warden ever to be selected to head a state correctional system in the nation.” It now appears that Williams still has some loyalty to his former employer, and in refusing to penalize GEO for its clear violation of its contract, is exhibiting a clear conflict of interest.

  • Rick Scott’s Immigrant Running Mate Accused Of ‘Evading’ Questions On Immigration

    Last week, gubernatorial candidate Rick Scott (R-FL) tapped Jennifer Carroll (R-FL), an African American immigrant from Trinidad, to share the Republican ticket with him as lieutenant governor. “Working together, we will broaden the base of our party,” Scott said as he introduced Carroll. However, if Scott hopes to use Carroll to broaden a minority base that includes disgruntled Latino and immigrant voters who he has isolated via his hardline immigration stance, he may want to ask his running mate to brush up on her talking points. The Palm Beach Post published an awkward exchange between one of its reporters and Carroll:

    CARROLL: I agree with Rick and his position on legal immigration. Illegal immigration I do not support because I feel that we should not be rewarding illegal activities.

    PALM BEACH POST: But does that mean you support bringing an Arizona-style immigration enforcement law to Florida?

    CARROLL: Well let me you ask you back, what is your impression about Arizona-style immigration laws?

    PALM BEACH POST:What is my impression?

    CARROLL: Yes.

    PALM BEACH POST:It’s a law that requires police when enforcing other laws to check immigration status if there is a suspicion. [...]

    CARROLL: We haven’t gotten into the nitpicky as to how a bill is going to be crafted. There’s already a bill by Will Snyder that the House has already filed. What the containment of that bill is, how it is going to come out of the House or Senate, is another story

    PALM BEACH POST:Do you support Representative Snyder’s bill?

    CARROLL: I have not read the bill, so I cannot tell you.

    Watch it:

    During his primary against Bob McCollum (R-FL), Scott poured millions of dollars into ads supporting Arizona’s tough immigration law and advocating for one like it in Florida. Snyder’s immigration bill, which McCollum unveiled as part of his campaign platform, was largely a desperate response to Scott’s pandering on the issue. Since then, GOP Latino leaders have been publicly asking Scott to abandon his anti-immigrant rhetoric. So far, there is no indication that either he or his running mate is listening. Read more at the Wonk Room.

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You can't finally tell the truth through the mind, because the mental process is busy with damage control. But there are a few questions you can ask to support truth telling, and you can deeply examine and ruthlessly, often painfully, answer them.

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