The Physicians for a National Health Program single payer plan is only one Americans should support

The Physicians for a National Health Program National Health Plan http://www.pnhp.org/ is the only plan Democrats, or anyone, should accept from the primary candidate they vote for.

http://www.pnhp.org/facts/single_payer_resources.php


Single-Payer National Health Insurance

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 46 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, long-term care, mental health, 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 though 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 http://www.pnhp.org/single_payer_resources/physicians_proposal_intro.php

Key Features of Single-Payer
A useful handout detailing the main features of single-payer. http://www.pnhp.org/facts/key_features_of_singlepayer.php

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. http://www.pnhp.org/facts/dr_marcia_angell.php

Liberal Benefits, Conservative Spending
Another great introductory handout. http://www.pnhp.org/PDF_files/LiberalBenefitsConservativeSpending.pdf

Public Citizen's Response to the Citizens' Health Care Working Groups Interim Recommendations
A great overview on the benefits of a single-payer system by Public Citizen. http://www.pnhp.org/single_payer_resources/public_citizens_response_to_chcwg_interim_recommendations.php

Rep. Dennis Kucinich Tackles Health Care
Rep. Kucinich talks with Truthdig about the health care crisis in America. http://www.pnhp.org/news/2006/november/rep_dennis_kucinich.php

Single Payer: Facts and Myths

Single Payer FAQ
A frequently-updated catalog of the most-asked questions about single-payer. http://www.pnhp.org/facts/singlepayer_faq.php

Myths as Barriers to Health Care Reform
A paper refuting many of the myths associated with single-payer. http://www.pnhp.org/single_payer_resources/myths_as_barriers.php

“Mythbusters” by the Canadian Health Services Research Foundation
A series of brief papers debunking the common misconceptions about the Canadian health system. http://www.pnhp.org/single_payer_resources/mythbusters_by_the_canadian_health_services_research_foundation.php

“Moral Hazard:” The Myth of the Need for Rationing
http://www.pnhp.org/single_payer_resources/moral_hazard_the_myth_of_the_need_for_rationing.php

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
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. http://www.pnhp.org/single_payer_resources/introduction_how_much_would_a_singlepayer_system_cost.php


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 http://www.pnhp.org/single_payer_resources/administrative_waste_consumes_31_percent_of_health_spending.php

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 http://www.pnhp.org/single_payer_resources/administrative_costs_in_us_hospitals_are_more_than_double_canadas.php

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 http://www.pnhp.org/single_payer_resources/60_percent_of_health_spending_is_already_publicly_financed_enough_to_cover_everyone.php

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 http://www.pnhp.org/single_payer_resources/a_proposal_for_financing_national_health_insurance.php

"Liberal Benefits, Conservative Spending"
Grumbach, et al. JAMA, May 15, 1991, Vol. 265 No. 19 http://www.pnhp.org/publications/liberal_benefits_conservative_spending.php

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 http://www.pnhp.org/PDF_files/ForProfitCare.pdf

Devereaux, PJ “Payments at For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J., Jun 2004; 170 http://www.pnhp.org/single_payer_resources/forprofit_hospitals_cost_more_and_have_higher_death_rates.php

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 http://www.pnhp.org/single_payer_resources/forprofit_hospitals_cost_more_and_have_higher_administration_expenses.php

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 http://www.pnhp.org/single_payer_resources/forprofit_hmos_provide_worse_quality_care.php

For-Profit Medicare Plans Cost 11 Percent More Than Traditional Medicare
MedPac Report, Jun 9, 2006 http://www.pnhp.org/single_payer_resources/forprofit_medicare_plans_cost_11_percent_more_than_traditional_medicare.php

Quality and Malpractice

Introduction: Medical Malpractice, Health Care Quality and Health Care Reform (pdf)
A Forum Report by Gordon Schiff, MD http://www.pnhp.org/reader/Section%205%20-%20Quality%20and%20Malpractice%20Issues/Gordy%20Malpractice%20Primer.pdf

How Single-Payer Improves Health Care Quality (pdf)
A brief by PNHP (makes a great handout!) http://www.pnhp.org/facts/quality.pdf

A Better Quality Alternative: Single-Payer National Health Insurance -Schiff, et al
http://www.pnhp.org/single_payer_resources/a_better_quality_alternative_singlepayer_national_health_insurance.php


“A Better Quality Alternative” JAMA, 272(10); Sept. 12 1994 http://www.pnhp.org/single_payer_resources/a_better_quality_alternative_singlepayer_national_health_insurance.php


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 http://www.pnhp.org/reader/Section%205%20-%20Quality%20and%20Malpractice%20Issues/IOM%20Chasm%20Paper.pdf

The Failures of Other Reform Options

Individual Mandates (The Massachusetts Plan) http://www.pnhp.org/single_payer_resources/individual_mandates_the_massachusetts_plan.php

Consumer Directed Health Care and Health Savings Accounts http://www.pnhp.org/single_payer_resources/consumer_directed_health_care_and_health_savings_accounts.php

Tax Credits for Private Insurance http://www.pnhp.org/single_payer_resources/tax_credits_for_private_insurance.php

Why HSAs Won't Cure What Ails U.S. Health Care http://www.cmwf.org/publications/publications_show.htm?doc_id=405167&#doc405167

Critique of Sen. Wyden's (OR) "Healthy Americans Act" http://www.pnhp.org/news/2006/december/lewin_group_analysis.php

Comparison between Schwarzenegger Health Plan and Single Payer for California http://www.pnhp.org/news/2007/january/comparison_between_s.php

State Single-Payer Bills

Arizona
http://www.pnhp.org/PDF_files/AZSinglePayerBill.pdf

Colorado
http://www.pnhp.org/PDF_files/ColoradoSinglePayerBill.pdf

International Health Systems

I. Canada
The Canadian Health System: Lessons for the United States
US General Accounting Office Report, June 1991 http://www.pnhp.org/single_payer_resources/the_canadian_health_system_lessons_for_the_united_states.php

A Survey of the Canadian Health System - Armstrong, et al “A Perfect System?” excerpted from Universal Health Care, New York Press, 1998
http://www.pnhp.org/single_payer_resources/a_survey_of_the_canadian_health_system.php



A Survey of Studies Comparing the U.S. and Canada (pdf)
PNHP Brief, May 2006 http://www.pnhp.org/single_payer_resources/CAN_Comparison_Sheet.pdf

The Future of Health Care in Canada (pdf)
Report of the Romanow Commission http://www.pnhp.org/reader/Section%206%20-%20Canadian%20Health%20System/Message%20to%20Canadians.pdf


II. International Comparisons
The U.S. spends more for less because of its fragmented financing system - Anderson, G. et al, "It’s the Prices, Stupid: Why the United States is so Different from Other Countries," Health Affairs 22(3), May/June 2004-http://www.pnhp.org/single_payer_resources/the_us_spends_more_for_less_because_of_its_fragmented_financing_system.php



U.S. Care Quality is No Better Than Other Countries -Hussey, P. et al "How Does the Quality of Care Compare in Five Countries?" Health Affairs 23(3) May/June 2004 http://www.pnhp.org/single_payer_resources/us_care_quality_is_no_better_than_other_countries.php

Single-Payer Bibliography

A bibliography of single-payer studies and papers http://www.pnhp.org/reader/

100%

Great organization and we need to offer them all the support we can muster.

:kick:

doctors' lobby is virtually an arm of the Repub party.

From Colorado's site: http://www.healthcareforallcolorado.org/?p=7

Calif: http://www.healthcareforall.org/

Conn.: http://cthealth.server101.com/

Florida: http://www.ffhs.org/

Illinois - CbhcOnline.org

Maine Maine's People Alliance.org

Maryland - HealthCareForAll.com

Massachusetts
Masscare.org
Massachusetts Campaign For Single Payer Health Care, (MASS-CARE)is a coalition of over 80 organizations which are dedicated to work for universal single payer health care in Massachusetts.


MassDefendHealthCare.org
Health care should be accessible to all regardless of employment, education, social, economic cultural or linguistic status. Financial, geographic, and organizational barriers should not limit access to care.


Massachusetts Nurses Association
Minnesota - CoAct.org

Missouri - MOSP.MISSOURI.ORG

North Carolina - NcDefendHealthCare.org

Oregon - HealthCareForAllOregon.org

New Mexico - www.HealthActionNM.org

New York - PnhpNyc.org

Ohio - SpanOhio.org

Pennsylvania - PhillyHealth.org

Rhode Island - EveryBodyInNobodyOut.org/ri/

Tennessee - www.thcc2.org

Texas - ProTex.org/hcfat/

Utah - UtahHealthAlliance.org

Vermont - VtHca.org

Wisconsin - WisconsinHealth.org

If your state isn't listed, contact a nearby state with an organization, request speakers, and advice on how to form an organization!

We will get health care when we DEMAND IT!

People don't realize how large a fraction of medical costs is already picked up by public payers, through Medicare, Medicaid, or TRICARE. By focusing on the working population (and age group!), while letting the government pick up the older and the poorer and those in harm's way, private insurance has essentially skimmed the cream of market. The truth is we don't have a private medical system. We have a public medical system in the areas that are difficult, and private insurance where that is least risky for the insurer.

:hippie:

I'm almost ashamed to share any related links I have saved but here's a pretty good OP that salin put up a year ago. It predicts how Junior will try to use Health Savings Accounts as part of a plan to eliminate employer paid healthcare - with no corresponding equivalent coverage like universal healthcare to replace it. It convinced me we need to avoid HSA proposals like the plague.

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=364&topic_id=210673

FWIW I'm in favor of getting employers out of the healthcare business, but not if employees just end up with less or nothing - which is actually what's goin on now. If you look around you'll see that the employers who still offer healthcare are reducing and capping it.

Edit to add: Here's a poll that shows just 33% favor national health insurance. It the survey is accurate, most believe employers should be forced to cover employees. Looks like we've got a lot of work to do.

http://www.rasmussenreports.com/Political%20Tracking/Dailies/nationalHealthInsurance-EdwardsPlan.htm

The ERIC conference is called to order (play ominous Snidely Whiplash music in the background)

Chaiman sneers, "Slither to your seats, the coven will be in order." (hissing)

And now we're going to show you how to steal promised medical benefits from your employees. (applause). You can report the elimination of future liabilities as present and future earnings. That way you can declare profits you didn't really earn and make it look like you actually know how to run corporations and accordingly take even more obscene compensation than you have been giving yourselves already. (applause, hiss hiss) Because our money is more important than their lives. (applause, hiss hiss, slithering ovation) Just think of all those employees, their wives and their children, suffering without healthcare benefits that they have earned, so that you can have another billion dollars (laughter).

Think that about covers it?

I suspect that if single-payer were explained to people. And it's pretty easy to explain -- we all contribute to the fund and can go to any doctor/hospital and our care is paid from the fund -- kind of like Social Security! No insurance company overhead for multi-million dollar CEO salaries or corporate jets, etc. Grind the pharmaceutical companies prices down (we'll pay you xxxx or we'll go overseas)...

Easy. Then watch the numbers race higher...


Not suprising -- from the Rasmussen site:

"There is also a significant partisan divide. Republicans oppose national health insurance by a 52% to 21% margin. Democrats tend to favor it (44% to 31%)."

And that's "national health insurance". If one used the words "single payer healthcare" you'd get a much higher percentage say 'yes'...

The Singapore Healthcare System makes so much sense it's no wonder it doesn't have a chance of being adopted in the US. I don't have the author or link for this article but it's from www.prudentbear.com ... the archive is down at the moment.

One possible model for the healthcare system has existed since 1984, in Singapore's Central Provident Fund (motto "Integrity, Service, Excellence" – not what one finds in government bodies nearer home!) This compulsory savings scheme provides for healthcare, retirement, life insurance and home ownership, provides accounts that remain the property of the individual at all times and offers a variety of investment options. Contributions are 33% of employees' wages until age 50 of which 13% is paid by the employer; the contributions scale down at higher ages. For the self-employed, the system is limited to a medical savings account, with premiums of 6-8% of earnings. There is also a catastrophic medical insurance scheme, for early major illnesses. Medical costs are paid directly out of the CPF Fund, and the saver is advised to stay in "affordable wards" to make his Medisave funds go further. Funds can be withdrawn on retirement, subject to retention of a minimum sum, converted to an annuity for basic living expenses and a Medisave minimum for end-of-life medical expenses. At death, an individual's CPF holding is transferable to his heirs.

The principal benefit of the Singapore system is that it makes almost all healthcare costs payable by the patient, directly from his healthcare savings account. There are no insurance intermediaries adding costs, determining what treatments are acceptable, or negotiating in their own interest with healthcare providers, attempting to get cost discounts compared with the uninsured. Hospitals and other healthcare providers are forced to provide a transparent fees schedule, and estimates of cost in advance of treatment, so that the patient or his near relatives can make an informed decision as to which treatments to select.

Needless to say, the Singapore system is so sensible that it is most unlikely to be adopted in Britain or the U.S. Although the compulsory savings must seem high to the young, tax rates are correspondingly lower; the top marginal rate of Singapore's individual income tax is only 20%, so tax plus CPF contribution totals a maximum marginal 40%, still reasonable. Furthermore, by diverting health and retirement payments to the private sector, with contributions and payments administered through the CPF, it reduces the size of government itself, which in Singapore absorbs only 16% of GDP, far below its percentage in the U.S. or Europe.

By reducing the proportion of the economy administered by third parties, and forcibly raising the national savings rate, the CPF system brings two huge economic benefits which would enormously help the performance of both the US and British economies. It need hardly be added that by reducing the resources available to government, the CPF also reduces corruption; Singapore ranks fifth on the Transparency International Corruption Perceptions Index, with a 9.4 ranking, compared to the U.S. at 20th with 7.3.

to provide quality basic health care to the general population.

By not being progressive in taxation Singapore is a haven for the rich, producing a very highly taxed middle class that must be controlled - it is a representative democracy calling itself a parliamentary republic, but a place where the People's Action Party has won every election since self-government in 1959. The Economist Intelligence Unit lists Singapore as a country with a "hybrid" system with democratic and authoritarian elements. Freedom House ranks the country as "partly free". Though general elections are free from irregularities and vote rigging, the PAP has been criticized for manipulating the political system through its use of censorship, gerrymandering and civil libel suits against opposition politicians.

favored by the GOP

:evilgrin:

They went from being anti-universal-care to "we're going to have to do something to fix this mess" in relatively few years.

Talked to a Good Old Boy who was one of the only docs in his specialty serving the entire eastern half of his state, and he made a comment about "Hillarycare". At first, I thought he was making a Faux-"News" type slur, but when I asked what he meant, it turned out he was disappointed that the Clintons had been unable to get universal health care his Appalachian patient base so desperately needs.

If they are unaware, it might spur their efforts!

Thanks for discussing it with them! :thumbsup:

"predetermined" for particular procedures that were far less than doctors felt was warranted. That, and the combined time and money necessary to process the tons of paperwork required by these companies combined to "convert" them. Welcome on board, doctors of America. It's about time.

Her proposal left the insurance companies intact, like they now function in Medicare Part D. If she had gone with single payer from the start we would have universal healthcare today.

It's good that this doctor is in favor of universal healthcare in any form though. That's sure a step in the right direction.

and relied on the AMA lobby to tell him their view of what was happening at the time.

But now, as previous posters have pointed out, he's seeing the effects on his patients, and (like 95% of the doctors I talk to) he really does care a lot about these people, and wants the system fixed.

is that if Health Insurance companies were taken out of the picture, costs would go down dramatically. Its obvious why they don't, you aren't going to win elections going after such a large and powerful lobby.

and... drum roll, lead to the firing of people

That said, cost benefit analysis... yes some folks will looose their work, but the benefits to the commons are impressive

And I do not think the upper management will loose anything either

to Medicare processing claims - just as the Insurance companies today beg for administrative only contracts from Medicare Part B, and then if they win the contract, they use their clerical staff to process those Medicare claims.

Many folks move into jobs that are more productive to society - but for the vast majority of the non executive staff, there is no change.

http://opensecrets.org/industries/indus.asp?Ind=F09

And that's just for federal -- does not include state lobbying.

We're going to get something that's called "a compromise." It's probably going to be mandatory enrollment in health insurance with the threat of penalty. For those who can't qualify because of "pre-existing conditions" and for those who are too poor, they're going to be dumped into a high risk pool where the lowest bidder wins the contract to administer to them care, and there's serious danger of the care being offered to the high risk pool being sub-standard due to the company wanting to cut costs even more like that Halliburton subsidiary at Walter Reed and Building 18.

work.

Really, this is an important part of the economy that needs to be managed by professional businessmen, not by people like doctors and nurses. The invisible hand of the market does a much better job on your annual physical than some damn doctor.

the market is the best distributor of scarce resources. In other words, those who can afford to pay are those who get care. Or thems what got is thems what gets.

n/t

:kick:

This is a fine video to explain to those who don't understand what single-payer really is, or have misconceptions. Please share this widely!

http://www.grahamazon.com/sp/whatissinglepayer.php

Anything else is likely to be an expensive subsidy to the insurance and drug industries.

HR676 in the House

SB840 in California

about their program for almost ten years now, yet I'm painfully aware that nothing will happen if we don't deal with the health insurance companies first. I think that first we are going to have to take all the government health care programs from Medicare on through CHAMPUS, CHIPS, Medicaid and many others and put them under one umbrella. They already amount to 60% of our national health care plans.

Then we need to sell this new and improved plan on the open market to unions, companies and individuals. The government can undercut the insurance companies in this and run them out of the health care business. Then we can fully implement the PNHP's plan.

Health care in the United States is a mess. Even for people who have money and good insurance it's not good. Yes, some of the best health care in the world can be found in the United States, but that doesn't mean you are going to get it, no matter what kind of insurance you've got.

Single payer national health insurance would improve health care for everyone.
]
I especially can't see why business doesn't support it. I can't imagine why any business would chose to deal with the chaos of employee health plans, etc.

even the companies want it

Remember, Canada started on the road to national single payer by instituting it in just one province--Saskatchewan.

this way of managing health care makes so much sense. when i discuss it with people i ask them if they think it would have made sense to block the automobile industry to protect the horseshoers and wagon makers.

k & r

because this issue should be up front more than it is.