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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 ($8,160 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 51 million completely uninsured and millions more inadequately covered.

Health Profits Cartoon

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. As a result, administration consumes one-third (31 percent) of Americans’ health dollars, most of which is waste.

Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork, more than $400 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 no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. 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, based on ability to pay, 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

Single Payer—Fifty Players? Alternative Payers for Universal Health Insurance
By Thomas Bodenheimer, MD

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

The case for an improved Medicare for All

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

Two-thirds of Americans support Medicare for all
By Kip Sullivan, J.D.


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

Quality of Care Under Single Payer National Health Insurance (pdf)
G. Schiff, 4/2007


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

Side-by-side comparison of state single-payer bills
A comparison of the California, Maryland, Minnesota, Pennsylvania, and Wisconsin state single-payer bills.

Arizona

California - SB810

Colorado

Delaware

Illinois

Maryland (2011)

Minnesota

New Mexico

New York

North Carolina

Ohio

Oregon

Washington


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

The National Health Program Reader

Evidence based talking points on single payer

A bibliography of single-payer studies and papers


Other Resources

Single-payer cartoons