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Say Yes to National Health Care

David HimmelsteinMichael Hochman

Michael Moore's film Sicko gave a big boost to the movement for single-payer national health insurance this year. But even those turned off by Mr. Moore's less-than-subtle style will find many reasons to support a single-payer system. As the number of uninsured and underinsured Americans continues to rise and medical costs spiral out of control, these reasons are increasingly compelling.

As doctors at an urban hospital, we see uninsured patients in the emergency room with serious illnesses that easily could have been prevented with appropriate preventive care. We waste countless hours filling out unnecessary insurance forms. And we listen to patients complain about the complexities and hassles of navigating the health care system.

This is why an increasing number of us on the front lines have started calling for meaningful change in the form of a single-payer system in which the government funds health care.

Next weekend, proponents of single payer will gather in Washington for the annual convention of Physicians for a National Health Program. Our group has proposed giving every U.S. resident a health care card entitling him or her to all medically necessary services. The new program would be funded by an increase in taxes, but that would be fully offset by savings from abolishing insurance premiums and many out-of-pocket health care costs. Those wanting cosmetic and other medically unnecessary services could still pay out of pocket.

Opponents of a single-payer system argue that single payer could be even more inefficient and bureaucratic than the current system. They point to other countries, such as Canada, that have national health insurance and yet have long wait times to see doctors.

But research supports the opposite conclusion. For example, a 2003 study published in The New England Journal of Medicine found that the average overhead of U.S. insurance companies is 11.7 percent, compared with 3.6 percent for Medicare and 1.3 percent for Canada's national health insurance program. And the waits in Canada are a result of Canada's low level of health spending - on a per capita basis, about half that in the United States. The efficiency of Canada's national health insurance program coupled with our current high level of health funding would yield the world's best health care system.

There is no reason to expect, as some people do, that reckless use of health care resources would increase under a single-payer system. Other countries that offer free health care spend much less than we do, and even now, most Americans don't "feel" the cost of health care because insurance companies pay many of the bills.

Some also suggest that the quality of health care would decline under a single-payer system. But again, this is unlikely. Life expectancy is shorter and infant mortality rates are higher in the United States compared with most nations with a single-payer system, and a comprehensive analysis has found that Canadians receive care at least as good as most insured Americans. The only difference would be that instead of sending bills to private insurance companies - a difficult and time-intensive process - doctors and hospitals would bill the national health insurance program.

Medical innovation would also continue unfettered. The vast majority of basic science in the United States is publicly funded, and incentives for drug development would remain strong.

Despite the merits of a single-payer system, none of the major 2008 presidential candidates supports it. Instead, they have put forth a creative array of meaningless, incremental reforms that would do little for our failing system.

For example, Mitt Romney's Massachusetts Health Reform - which requires citizens to purchase health insurance or face a fine - is proving far more complicated and far less comprehensive than many had hoped.

Proposals from Democratic Sens. Barack Obama of Illinois and Hilary Rodham Clinton of New York also fall far short. Under both of their plans, only low-income citizens who qualify for Medicaid or the State Children's Health Insurance Programs would be guaranteed health care. The rest would be required to buy their own, effectively criminalizing the uninsured.

Although few mainstream politicians endorse single payer, we see reason for optimism. A recent survey of Massachusetts physicians found that almost two-thirds favor single payer, and we believe health care providers are coming around nationwide as well. We hope the political thrust for single payer will come soon. If it doesn't, we face a future of more wasteful spending, more inefficiency - and ever more Americans struggling to get by without health insurance.

Our work is licensed under Creative Commons (CC BY-NC-ND 3.0). Feel free to republish and share widely.
David Himmelstein

David Himmelstein

Dr. David Himmelstein is a co-founder of Physicians for a National Health Program. He is a professor of public health at the City University of New York and visiting professor of medicine at Harvard Medical School. He has served as the chief of the division of social and community medicine at Cambridge Hospital where he practices primary care internal medicine, and co-founded the Center for a National Health Program Studies at Harvard.

Michael Hochman

Michael Hochman

Dr. Michael Hochman, is a member of the Massachusetts chapter of Physicians for a National Health Program

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