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NAVIGATION
PNHP RESOURCES

Evidence Based Talking Points

Talking Point 1: Administrative costs consume 31 percent of health spending, most of it unnecessary.

Costs of Health Care Administration in the U.S. and Canada.” Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003), N Engl J Med, 349, 768-775.


Talking Point 2: Nearly two-thirds of all bankruptcies are caused by medical bills. Three-fourths of those bankrupted had health insurance at the time they got sick or injured. 

Medical Bankruptcy in the United States, 2007: Results of a National Study.” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009), Am J Med, 122, 741-746.

Medical Bankruptcy Fact Sheet.” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009).

Medical Bankruptcy Q&A.” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009).


Talking Point 3: Taxes already pay for more than 60 percent of US health spending Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it.

Paying for National Health Insurance - And Not Getting It.” Woolhandler, S. & Himmelstein, D.U. (2002), Health Affairs 21(4), 88-98.


Talking Point 4: Despite spending far less per capita for health care, Canadians are healthier and have better measures of access to health care than Americans. Taiwan’s new single payer system (adopted in 1996) has improved access to care (before its adoption, 40 percent of the population was uninsured), controlled costs, and is model of efficiency. Despite having the highest per capita health spending in the world, the U.S. health system ranks very poorly in international comparisons of quality, outcomes, patient satisfaction, and other measures.

Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” Lasser, K., Himmelstein, D.U., & Woolhandler, S. (2006), Am J Public Health, 96, 1300-1307.

Does Universal Health Insurance Make Health Care Unaffordable? Lessons from Taiwan.” Lu, J.F.R. & Hsiao, W.C. (2003), Health Affairs, 22(3), 77-88.

Learning from Taiwan: Experience with Universal Health Insurance.” Davis, K. & Huang, A.T. (2008), Ann Intern Med, 148, 313-314.

It’s The Prices, Stupid: Why The United States is So Different From Other Countries.” Anderson, G., Reinhardt, U.E., Hussey, P.S., & Petrosyan, V. (2003), Health Affairs, 22(3), 89-105.


Talking Point 5: Business pays less than 20 percent of our nation’s health bill. It is a misnomer that our health system is “privately financed.” 60 percent is funded by taxes and the remaining 20 percent is out-of-pocket payments.

A Reappraisal of Private Employers’ Role in Providing Health Insurance.” Carrasquillo, O., Himmelstein, D.U., Woolhandler, S., & Bor, D.H. (1999), N Engl J Med, 340, 109-114.


Talking Point 6: For-profit, investor-owned hospitals, HMOs, and nursing homes have higher costs and score lower on most measures of quality than their non-profit counterparts. For-profit hospitals have higher death rates.

The high costs of for-profit care.” Himmelstein, D. & Woolhandler, S. (2004), Can Med Assoc J, 170, 1814-1815.

Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis.” Devereaux, P.J., et. al. (2004), Can Med Assoc J, 170, 1817-1824.

A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals.” Devereaux, P.J., et. al. (2002), Can Med Assoc J, 166, 1399-1406.

Costs of Care and Administration at For-Profit and Other Hospitals in the United States.” Woolhandler, S., & Himmelstein, D.U. (1997), N Engl J Med, 336, 769-775.

Quality of Care in Investor-Owned vs. Not-for-Profit HMOs.” Himmelstein, D.U., Woolhandler, S., Hellander, I., & Wolfe, S.M. (1999), J Am Med Assoc, 282, 159-163.

Does Investor Ownership of Nursing Homes Compromise the Quality of Care?” Harrington, C., Woolhandler, S., Mullan, J., Carrillo, H., & Himmelstein, D.U. (2001), Am J Public Health, 91, 1452-1455.

Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.” Vikram R Comondore, P J Devereaux et al,  BMJ 2009;339:b2732, doi: 10.1136/bmj.b2732, Aug. 4, 2009.


Talking Point 7: Immigrants and emergency department visits by the uninsured are not the cause of high and rising health care costs.

Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis.” Mohanty, S., et. al. (2005), Am J Public Health, 95, 1431-1438.

US Emergency Department Costs: No Emergency.” Tyrance, P.H., Himmelstein, D.U., & Woolhandler, S. (1996), Am J Public Health, 95, 1527-1531.


Talking Point 8: The uninsured do not receive all the medical care they need: one-third of uninsured adults have chronic illness and don’t receive needed care. Those most in need of preventive services are least likely to receive them.

A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults.” Wilper, A., et. al. (2008), Arch Intern Med, 149, 170 - 176.


Talking Point 9: The U.S. could save enough on administrative costs (almost $400 billion in 2009) with a single-payer system to cover the uninsured.

Costs of Health Care Administration in the U.S. and Canada.” Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003), N Engl J Med, 349, 768-775.

Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance.” Woolhandler, S., Himmelstein, D.U., Angell, M., & Young, Q.D. (2003), J Am Med Assoc 290, 798-805.

Summary of Fiscal Studies: How Much would Single Payer Cost?

Canadian Health Insurance: Lessons for the Unites States.” U.S. General Accounting Office. (1991), GAO/HRD-91-90 Canadian Health Insurance.


Talking Point 10: Competition among investor-owned, for-profit entities has raised costs reduced quality in the U.S.

Competition in a publicly funded healthcare system.” Woolhandler, S. & Himmelstein, D.U. (2007), Brit Med J, 335, 1126-1129.

Market-Based Failure – A Second Opinion on U.S. Health Care Costs.” Kuttner, R. (2008), N Engl J Med, 358, 549-551.


Talking Point 11: The Canadian single payer healthcare system produces better health outcomes with substantially lower administrative costs than the United States.

A systematic review of studies comparing health outcomes in Canada and the United States.” Guyatt G.H., et al. (2007), Open Medicine, 1, E27-36.

Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” Lasser, K., Himmelstein, D.U., & Woolhandler, S. (2006), Am J Public Health, 96, 1300-1307.

Who administers? Who cares? Medical Administrative and Clinical Employment in the United States and Canada.” Himmelstein, D., Lewontin, J.P., & Woolhandler, S. (1996), Am J Public Health, 86,172-178.

Costs of Health Care Administration in the U.S. and Canada.” Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003), N Engl J Med, 349, 768-775.

Mythbusters: Canada has a communist-style healthcare system.” Canadian Health Services Research Foundation. (2005).

Mythbusters: The cost of dying is an increasing strain on the healthcare system.” Canadian Health Services Research Foundation. (2003).

Mythbusters: User fees would stop waste and ensure better use of the healthcare system.” Canadian Health Services Research Foundation. (2001).

Privatizing health care is not the answer: lessons from the United States.” Angell, M. (2008), Can Med Assoc J, 179, 916-919.


Talking Point 12: Computerized medical records, chronic disease management, and malpractice reform do not save money. The only way to slash administrative over-head and improve quality is with a single payer system.

"Hospital computing and the costs and quality of care: a national study." Himmelstein, D.U., Wright, A & Woolhandler, S. (2009), Am J Med, 2009 Nov 16.

Hope And Hype: Predicting The Impact Of Electronic Medical Records.” Himmelstein, D.U. & Woolhandler, S. (2005), Health Affairs, 24, 1121-1123.

Disease Management: Panacea, Another False Hope, or Something in Between?” Geyman, J. (2007), Ann Fam Med, 5, 257-260.

Costs of Health Care Administration in the U.S. and Canada.” Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003), N Engl J Med, 349, 768-775.

A Better Quality Alternative: Single-Payer National Health System Reform.” Schiff, G.D., Bindman, A.B., & Brennan, T.A. (1994), J Am Med Assoc, 272, 803-808.

How Single-Payer Health System Reform Improves Quality.” PNHP Document

You Can’t Leap a Chasm in Two Jumps: The Institute of Medicine Health Care Quality Report.” Schiff, G.D. & Young, Q.D. (2001), Public Health Rep, 116, 396-403.

Medical Malpractice. Health Care Quality and Health Care Reform.” Schiff, G. (2003), Forum Report #4. PNHP NY Metro.


Talking Point 13: Alternative proposals for “universal coverage” (e.g. based on the Federal Employees Health Benefits Program, the old “Clinton health plan” or the recent reform in Massachusetts) do not work. State health reforms over the past two decades have failed to reduce the number of uninsured.

State Health Reform Flatlines.” Woolhandler, S., Day, B., & Himmelstein, D.U. (2008), Int J Health Serv, 38, 585-592.

FEHBP: A Feeble Model for Universal Health Care.” Rodberg, L. & Landy, J. (2004), On the Issues #2. PNHP NY Metro.

Health Reform You Shouldn’t Believe In.” Angell, M. (2008), The American Prospect, April 21.

Getting the Facts Right: Why HillaryCare Failed.” Navarro, V. (2007), PNHP Newsletter.

The Massachusetts Way?” Rodberg, L. (2008), The New York Times, Sept. 26.


Talking Point 14: Drug companies spend more on marketing (31 percent) and profits (20 percent) than on R & D (13 percent). Lower drug prices would not jeopardize drug innovation, much of which is, in fact, publicly-funded.

Extraordinary Claims Require Extraordinary Evidence.” Light, D.W. & Warburton, R.N. (2005), J Health Econ, 24, 1030-1033.

Global Drug Discovery: Europe Is Ahead.” Light, D.W. (2009), Health Affairs, web exclusive, w969-w977.

Will Lower Drug Prices Jeopardize Drug Research? A Policy Fact Sheet.” Light, D.W. & Lexchin, J. (2004), Am J Bioethics, 4, W3-W6.

Foreign Free Riders and the High Price of U.S. Medicines.” Light, D.W. & Lexchin, J. (2005), Brit Med J, 331, 958-60.


Talking Point 15: Co-pays and deductibles are not necessary to control costs and reduce necessary care as much as unnecessary care. It is a myth that patient overuse will bankrupt any system without cost-sharing and that the demand for healthcare is “infinite”.

Cost Sharing in Health Insurance – A Reexamination.” Rasell, M.E. (1995), N Engl J Med, 332, 1164-1168.

Health needs, health-care requirements, and the myth of infinite demand.” Frankel, S. (1991), Lancet, 337, 1588-1590.

Does universal comprehensive insurance encourage unnecessary use? Evidence from Manitoba says ‘no.’” Roos, N.P., Forget, E., Walld, R., & MacWilliam, L. (2004), Can Med Assoc J, 170, 209-214.


Talking Point 16: Universal coverage cannot be achieved with U.S.-style investor-owned private insurance companies. Every other industrialized, capitalist country has some form of non-profit national health care. For-profit, private insurance (mostly “gap” coverage) accounts for less than 5 percent of health expenditures in Europe.

International Health Systems for Single Payer Advocates.” Hellander, I.

PBS Frontline Interview with T.R. Reid, Fall 2008.” Reid, T.R. (2008).

Sick Around the World.” Reid, T.R. (2008).

Private health insurance and access to health care in the European Union.” Thompson, S. & Mossialos, E. (2004), Euro Observer, 6(1).

Health Care Systems - Four Basic Models.” Reid, T.R.

Health care reform must start with a plan to simplify.” McCanne, D. (2008), Quote of the Day, Sept. 18.


Talking Point 17: A majority of physicians (59 percent), and an even higher proportion of Americans (two-thirds) support single payer national health insurance or “Medicare for all.” Polling indicates that people are also willing to pay “higher taxes” for guaranteed coverage and that even the term “socialized medicine” has lost its negative connotations.

Support for National Health Insurance among U.S. Physicians: 5 Years Later.” Carroll, A.E. & Ackerman, R.T. (2008), Ann Intern Med, 148, 566.

Single-Payer, Health Savings Accounts, or Managed Care? Minnesota Physicians Perspective.” Albers, J.M., Lathrop, B.P., Allison, K.C., Oberg, C.N., & Hart, J.F. (2007), Minn Med, 90, February.

PNHP Backgrounder: Recent Public Polls on Single Payer.” PNHP. (2007).

PNHP Backgrounder: Physician Polls on Single Payer Prior to 2008.” PNHP. (2008).