A Physicians’ Proposal for Single-Payer Health Care Reform

AJPH Editorials: Moving Forward From the Affordable Care Act to a Single-Payer System

By Adam Gaffney, Steffie Woolhandler, David Himmelstein and Marcia Angell
American Journal of Public Health, June 2016
Published in advance online May 5, 2016


Despite the ACA, many serious problems remain in American health care. Uninsurance and underinsurance endure, bureaucracy is growing, costs are likely to rise, and caring relationships take second place to the financial prerogatives of health insurers and providers. A single-payer NHP offers a salutary alternative, one that a would at long last take the right to health care from the realm of political rhetoric to that of reality.


Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform

By The Working Group on Single-Payer Program Design
Co-chairs: Adam Gaffney, M.D., David U. Himmelstein, M.D., Steffie Woolhandler, M.D., M.P.H., and Marcia Angell, M.D.


Even after full implementation of the Affordable Care Act (ACA), tens of millions of Americans will remain uninsured or only partially insured, and costs will continue to rise faster than the background inflation rate. We propose to replace the ACA with a publicly financed National Health Program (NHP) that would fully cover medical care for all Americans, while lowering costs by eliminating the profit-driven private insurance industry with its massive overhead.  Hospitals, nursing homes, and other provider facilities would be nonprofit, and paid global operating budgets rather than fees for each service. Physicians could opt to be paid on a fee-for-service basis, but with fees adjusted to better reward primary care providers, or by salaries in facilities paid by global budgets.  The initial increase in government costs would be offset by savings in premiums and out-of-pocket costs, and the rate of medical inflation would slow, freeing up resources for unmet medical and public health needs.


Download the full proposal

Summary of the Physicians’ Proposal

Background Fact Sheet for the Physicians’ Proposal

PNHP Press Release


From the PNHP website

"Beyond the Affordable Care Act: A Physicians' Proposal for Single-Payer Health Care Reform" establishes the vision and principles that will empower Americans to replace our expensive, inadequate, and inefficient collection of health care systems with an improved Medicare for All.

The proposal outlines the general structure of a single-payer system for the United States, including coverage and eligibility; physician and outpatient care payment; global budgeting of hospitals; health planning and capital investments; coverage for medications, devices, and supplies; the establishment of a national long-term care program; cost-containment; and single-payer financing. The proposal also demonstrates the shortcomings of alternatives to National Health Insurance, including the Affordable Care Act.

For further links, including downloading and endorsing the proposal:



By Don McCanne, M.D.

If you have not done so already, please use the links above to endorse and download the Physicians’ Proposal, including the Summary and the Background Fact Sheet. It is imperative that we fix our dysfunctional health care system.