February, 21 2017, 09:15am EDT
For Immediate Release
Contact:
Clare Fauke, Communications Specialist,,clare@pnhp.org
Single-Payer Reform is 'the Only Way to Fulfill the President's Pledge' on Health Care: Annals of Internal Medicine Commentary
Researchers estimate administrative savings at $504 billion annually
Proposals floated by Republican leaders won't achieve President Trump's campaign promises of more coverage, better benefits, and lower costs, but a single-payer reform would, according to a commentary published today [Tuesday, Feb. 21] in Annals of Internal Medicine, one of the nation's most prestigious and widely cited medical journals.
Republicans promised to repeal the Affordable Care Act on the first day of the Trump presidency. But the health reform effort has stalled because Republicans in Congress have been unable to come up with a better replacement and fear a backlash against plans that would deprive millions of coverage and raise deductibles.
In today's Annals commentary, longtime health policy experts Drs. Steffie Woolhandler and David Himmelstein warn that the proposals by Speaker Paul Ryan, R-Wis., and Secretary of HHS Tom Price would slash Medicaid spending for the poor, shift the ACA's subsidies from the near-poor to wealthier Americans, and replace Medicare with a voucher program, even as they would cut Medicare's funding and raise the program's eligibility age.
Woolhandler and Himmelstein review evidence that, in contrast, single-payer reform could provide comprehensive first-dollar coverage to all Americans within the current budgetary envelope because of vast savings on health care bureaucracy and profits. The authors estimate that a streamlined, publicly financed single-payer program would save $504 billion annually on health care paperwork and profits, including $220 billion on insurance overhead, $150 billion in hospital billing and administration and $75 billion doctors' billing and paperwork. They estimate that an additional $113 billion could be saved each year by hard bargaining with drug companies over prices. A table in the paper summarizes these savings.
The savings would cover the cost of expanding insurance to the 26 million who remain uninsured despite the ACA, as well as "plugging the gaps in existing coverage - abolishing copayments and deductibles, covering such services as dental and long-term care that many policies exclude."
The lead author of the commentary, Dr. Steffie Woolhandler, is an internist, distinguished professor of public health and health policy at CUNY's Hunter College, and lecturer in medicine at Harvard Medical School. She said: "We're wasting hundreds of billions of health care dollars on insurance paperwork and profits. Private insurers take more than 12 cents of every premium dollar for their overhead and profit, as compared to just over 2 cents in Medicare. Meanwhile, 26 million are still uninsured and millions more with coverage can't afford care. It's time we make our health care system cater to patients instead of bending over backward to help insurance companies."
Dr. David Himmelstein, the senior author, is a primary care doctor and, like Woolhander, a distinguished professor at CUNY's Hunter College and lecturer at Harvard Medical School. He noted: "We urgently need reform that moves forward from the ACA, but the Price and Ryan plans would replace Obamacare with something much worse. Polls show that most Americans - including most people who want the ACA repealed, and even a strong minority of Republicans - want single-payer reform. And doctors are crying out for such reform. The Annals of Internal Medicine is one of the most respected and traditional medical journals. Their willingness to publish a call for single payer signals that it's a mainstream idea in our profession."
The Annals of Internal Medicine is the flagship journal of the American College of Physicians (ACP), the nation's largest medical specialty organization with 148,000 internal medicine physicians (internists), related subspecialists, and medical students. In 2007, the Annals published a lengthy policy article in which the ACP said a single-payer system was one pathway to achieving universal coverage. In early 2008, the journal published a study showing 59 percent of U.S. physicians support "government legislation to establish national health insurance," a leap of 10 percentage points from five years before.
Today's commentary is believed to be the first full-length call for single payer, or national health insurance, that the journal has published in its 90-year history.
*****
"Single-Payer Reform: The Only Way to Fulfill the President's Pledge of More Coverage, Better Benefits, and Lower Costs," by Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D. Annals of Internal Medicine. Published online first, Feb. 21, 2017. doi:10.7326/M17-0302.
Disclosures: Drs. Woolhandler and Himmelstein co-founded Physicians for a National Health Program (www.pnhp.org), a nonprofit educational and research organization that supports a single-payer national health plan; they also served as advisers to Sen. Bernie Sanders' presidential campaign. Neither the Sanders campaign nor PNHP played any role in funding or otherwise supporting the commentary.
Physicians for a National Health Program is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP has more than 21,000 members and chapters across the United States.
LATEST NEWS
'Chilling Attempt to Evade Accountability': Trump to Boycott UN Human Rights Review
One ACLU expert said the move sets "a terrible precedent that would only embolden dictators and autocrats and dangerously weaken respect for human rights at home and abroad."
Aug 28, 2025
The ACLU on Thursday condemned President Donald Trump's administration for refusing to participate in a United Nations mechanism "that calls for each UN member state to undergo a peer review of its human rights records."
The president's decision to ditch the Universal Periodic Review (UPR) follows a February executive order withdrawing from various world bodies, including the United Nations Human Rights Council (UNHRC), which he previously abandoned during his first term.
"The Trump administration's decision to boycott the UPR puts the US among the ranks of the worst violators of human rights," said Jamil Dakwar, director of the ACLU's Human Rights Program. "This move is a chilling attempt to evade accountability, setting a terrible precedent that would only embolden dictators and autocrats and dangerously weaken respect for human rights at home and abroad."
"The ACLU will continue to hold the Trump administration accountable for US human rights obligations and calls on Congress and state and local elected officials to join the fight to defend human dignity and everyone's basic rights and freedoms as promised by the Universal Declaration of Human Rights," Dakwar added.
trump/rubio say they're not participating in part b/c the council doesn't condemn human rights violators. THIS IS TOTAL BS. JOURNALISTS - please do not be stenographers on this. the council is far/very far from perfect. but it has been a major voice condemning violations globally.
— David Kaye (@davidakaye.bsky.social) August 28, 2025 at 11:22 AM
The Trump administration has faced mounting criticism since the February order, including after it missed an August 4 deadline to submit a national report in preparation for the next cycle of the UPR, set to take place in November.
After that deadline passed, the UPR Project at the United Kingdom's Birmingham City University and the UPR Academic Network released a joint statement noting that the US "participated in its previous three cycles of UPR in 2010, 2015, and 2020 and engaged as a recommending UN member state from the UPR's inception in 2008 until recently."
"The UPR is a nonconfrontational, cooperative mechanism which enables constructive dialogue between states on human rights. It is also a method of national self-reflection involving dialogue between civil society and the state," the signatories stressed, calling on the US to resume cooperation and other UN member states, UNHRC President Jürg Lauber, and the wider international community "to take appropriate steps and measures" encouraging the administration to do so.
The Lebanese Center for Human Rights (CLDH) reshared that statement on social media Thursday, declaring that the US position is "threatening global human rights accountability and international dialogue," and this is a "critical moment for human rights!"
The ACLU and CLDH comments came after Agence France-Presse confirmed the Trump administration's refusal to participate in the review, reporting on a Thursday letter that the US mission sent to UN High Commissioner for Human Rights Volker Türk.
According to AFP:
Thursday's letter said that the UPR system, which was created after the establishment of the rights council in 2006, was meant to be "based on objective and reliable information and conducted in a manner that ensures equal treatment" of all countries.
"However, this is not the case today," it charged, adding that "the United States objects to the politicization of human rights across the UN system, as well as the UN's unrelenting selective bias against Israel."
It also accused the UN of "ignoring human rights abuses in China, North Korea, Cuba and Venezuela," which it said had "tarnished the UPR process" and other rights council mechanisms.
UNHRC spokesperson Pascal Sim told the news agency that "since the inception of the UPR in 2008, the secretariat has occasionally received requests from states to postpone reviews," often due to national crises, and the council will discuss how to proceed on the US review when it meets for a month beginning September 8.
Thursday's letter and the backlash come after US Secretary of State Marco Rubio and his department put out an annual report on other nations' human rights conditions earlier this month—a day after a coalition of LGBTQ+ and human rights groups sued over the administration's delay in releasing the congressionally mandated publication.
Amanda Klasing, Amnesty International USA's national director of government relations and advocacy, said at the time that the report made "clear that the Trump administration has engaged in a very selective documentation of human rights abuses in certain countries." Other critics highlighted Israel as an example of this.
Charles Blaha, a former State Department official who now serves as a senior adviser at DAWN, which advocates for democracy and human rights in the Middle East, called it "functionally useless for Congress and the public " and "nothing more than a pro-Israel document."
Keep ReadingShow Less
Fed Gov. Lisa Cook Sues Trump Over 'Unprecedented and Illegal' Firing
The suit alleges a "pretextual" bid to oust Cook in order to "vacate a seat for President Trump to fill and forward his agenda to undermine the independence of the Federal Reserve."
Aug 28, 2025
US Federal Reserve Gov. Lisa Cook on Thursday filed an anticipated lawsuit in response to President Donald Trump's contentious attempt to fire her—something no president has ever done in the 111-year history of the central bank's governing body.
"This case challenges President Trump's unprecedented and illegal attempt to remove Gov. Cook from her position which, if allowed to occur, would the first of its kind in the board's history," says the lawsuit, which was filed in the District Court for the District of Columbia, and names Trump, the Fed Board of Governors, and Fed Chair Jerome Powell as defendants.
The suit contends that Cook's termination "would subvert the Federal Reserve Act... which explicitly requires a showing of 'cause' for a governor's removal, which an unsubstantiated allegation about private mortgage applications submitted by Gov. Cook prior to her Senate confirmation is not."
The US Department of Justice last week launched a criminal investigation of alleged mortgage fraud committed by Cook. The DOJ referral accuses Cook of misrepresenting her primary residence information on mortgage documents for two properties in 2021 in order to secure more favorable loan terms.
Cook—who has not been criminally charged—denies any wrongdoing.
"The unsubstantiated and unproven allegation that Gov. Cook 'potentially' erred in filling out a mortgage form prior to her Senate confirmation does not amount to 'cause,'" the lawsuit argues. "Allowing the president to remove members of the board over policy disagreements would also render illusory the board's independence."
"The mortgage allegations against her are pretextual, in order to effectuate her prompt removal and vacate a seat for President Trump to fill and forward his agenda to undermine the independence of the Federal Reserve," the filing adds.
Cook's suit asks a federal judge to declare that Trump's bid to remove her is an illegal violation of her due process rights, that Fed governors may only be fired for cause, and that the unproven mortgage fraud claim does not constitute such cause. She is also seeking an injunction to bar Powell and the Fed board from firing her.
Trump's effort to fire Cook has been condemned by critics as another attempt to bully the Fed and Powell as the White House pressures the central bank to cut interest rates. Powell signaled last week that the Fed is inclined to lower interest rates during its meeting next month.
Cook is the third Trump political foe accused of mortgage fraud by his administration.
Federal Housing Finance Agency (FHFA) Director William Pulte, a Trump appointee, has also targeted Democratic New York Attorney General Letitia James, who successfully sued the president and the Trump Organization for fraud, as well as Sen. Adam Schiff (D-Calif.), who was the lead manager in the first of Trump's two House impeachments.
Cook, a nominee of former President Joe Biden, has served on the Fed Board of Governors since 2022. Her term is not set to expire until 2038. She is the first Black woman to serve as a Fed governor.
Responding to Cook's lawsuit, White House spokesperson Kush Desai said in a statement that Trump had cause to fire the governor because she was "credibly accused of lying in financial documents from a highly sensitive position overseeing financial institutions."
However, Cook's alleged offense occurred the year before she joined the Fed board.
The president's bid to oust Cook could backfire—for him and Pulte—as the discovery process of her lawsuit may reveal "if the White House ordered a Trump loyalist to move against her," according to journalist Greg Sargent.
Keep ReadingShow Less
'Shut Up... You Should Be Fired': RFK Jr. Sparks Backlash With CDC Purge, School Shooting Remarks
"He is a dangerous man who is determined to abuse his authority to act on truly terrifying conspiracy theories and disinformation," said Democratic Sen. Patty Murray.
Aug 28, 2025
Some US elected officials are now calling for the firing of Health and Human Services Secretary Robert F. Kennedy Jr. amid mass resignations at the Centers for Disease Control and Prevention and comments he made about Wednesday's mass shooting at a Catholic school.
Sen. Patty Murray (D-Wash.) was the first Democratic lawmaker to call for Kennedy's firing on Wednesday night, shortly after news broke that he had ousted Centers for Disease Control and Prevention (CDC) Director Susan Monarez, who had just been confirmed by the US Senate weeks ago. Monarez's firing subsequently triggered several other high-profile resignations at the agency.
"If there are any adults left in the White House, it's well past time they face reality and fire RFK Jr.," she said. "He is a dangerous man who is determined to abuse his authority to act on truly terrifying conspiracy theories and disinformation—leaving us unprepared for the next deadly pandemic and snuffing out potential cures while he's at it."
Kennedy further angered his critics when he appeared on Fox News Thursday morning and not only defended the purge of the CDC, but also baselessly linked this week's mass shooting at the Annunciation Church in Minneapolis with the use of selective serotonin reuptake inhibitors (SSRIs), a class of drugs commonly used to treat clinical depression.
While speaking with the hosts of "Fox & Friends," Kennedy said that "we're launching studies on the potential contribution of some of the SSRI drugs and some of the other psychiatric drugs that might be contributing to violence" such as the shooting in Minneapolis on Wednesday that left two children dead and 17 other people wounded.
This drew the ire of Sen. Tina Smith (D-Minn.), who profanely called out Kennedy for peddling misinformation.
"I dare you to go to Annunciation School and tell our grieving community, in effect, guns don't kill kids, antidepressants do," she wrote in a social media post. "Just shut up. Stop peddling bullshit. You should be fired."
She then wrote a follow-up post in which she noted that "there are 400 million guns in this country," which is larger than the entire population of the US.
"In America, we are 10 times more likely to be shot in a school or playground than any other developed nation," she said.
Rep. Joe Neguse (D-Colo.) didn't explicitly call for Kennedy to be fired, although he labeled the HHS secretary's actions "disgraceful."
"What is happening at the CDC is truly a five-alarm fire and not receiving nearly enough attention," he wrote. "RFK Jr.'s undermining of our public health institutions will have disastrous consequences for generations."
Democratic lawmakers weren't the only ones calling for Kennedy's firing. Pradheep Shanker, a radiologist who regularly writes for the conservative National Review, also said he'd seen enough of US President Donald Trump's HHS Chief.
"RFK is a complete failure, and is making Trump's health policy look like a complete circus," he said. "If Trump has any credibility, he'll fire RFK."
Keep ReadingShow Less
Most Popular