The National Health Program Reader

Edited by Ida Hellander, M.D. and Matthew Petty

Edition 3.3, Updated on October 21, 2011

Section I: PNHP’s Proposal for Single-Payer National Health Insurance

  • Physicians’ Proposal for Single-Payer National Health Insurance (JAMA, 2003)
  • Frequently Asked Questions

Section II: The Evidence-Based Case for Single Payer National Health Insurance

Topic A: Patients need single payer

  • Talking Point 1: Nearly two-thirds of all bankruptcies are caused by medical bills; three-quarters of those bankrupted had health insurance at the time they got sick or injured.
  • Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009). “Medical Bankruptcy in the United States, 2007: Results of a National Study.” Am J Med, 122, 741-746.
  • Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009). “Medical Bankruptcy Q&A.”
  • Talking Point 2: The uninsured do not receive all the medical care they need: 45,000 die annually. One-third of uninsured adults have a chronic illness and don’t receive needed care.
  • Wilper, A., et. al. (2009). “Health Insurance and Mortality in U.S. Adults.” Am J Public Health, 99, 2289-2295.
  • Press Release for Wilper, A., et. al. (2008). “A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults.” Arch Intern Med, 149, 170-176.

Topic B: We can afford single payer

  • Talking Point 3: Administrative costs consume 31 percent of health spending, most of it unnecessary. The U.S. could save enough on administrative costs (almost $400 billion in 2009) with a single-payer system to cover the uninsured.
  • Woolhandler, S., Campbell, T., & Himmelstein, D.U. (2003). “Costs of Health Care Administration in the U.S. and Canada.” N Engl J Med, 349, 768-775.
  • Talking Point 4: Taxes already pay for more than 60 percent of US health spending, and business pays less than 20 percent. Americans pay the highest health care taxes in the world; we pay for national health insurance, but we don’t get it.
  • Woolhandler, S. & Himmelstein, D.U. (2002). “Paying for National Health Insurance - And Not Getting It.” Health Affairs 21(4), 88-98.
  • Talking Point 5: The U.S. spends more per capita on health care than other nations.
  • OECD Health Data 2011 (excerpted charts)

Topic C: Single payer ensures high quality health care

  • Talking Point 6: Single-payer national health insurance is the best way to ensure high-quality health care.
  • Schiff, G.D., Bindman, A.B., & Brennan, T.A. (1994). “A Better Quality Alternative: Single-Payer National Health System Reform.” J Am Med Assoc, 272, 803-808.
  • Talking Point 7: Other countries have high quality care with lower levels of amenable mortality.
  • Nolte, E. & McKee, M. (2011). “Variations in Amenable Mortality – Trends in 16 High-Income Nations.” Health Policy.
  • Talking Point 8: Competition among investor-owned, for-profit entities – including hospitals, HMOs, hospice care, and nursing homes – increases costs and degrades quality.
  • Woolhandler, S. & Himmelstein, D.U. (2007). “Competition in a publicly funded healthcare system.” Brit Med J, 335, 1126-1129.
  • Himmelstein, D. & Woolhandler, S. (2004). “The high costs of for-profit care.” Can Med Assoc J, 170, 1814-1815.
  • Devereaux, P.J., et. al. (2004). “Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis.” Can Med Assoc J, 170, 1817-1824.
  • Devereaux, P.J., et. al. (2002). “A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals.” Can Med Assoc J, 166, 1399-1406.
  • Himmelstein, D.U., Woolhandler, S., Hellander, I., & Wolfe, S.M. (1999). “Quality of Care in Investor-Owned vs. Not-for-Profit HMOs.” J Am Med Assoc, 282, 159-163.
  • Perry, J.E. & Stone, R.C. (2011). “In the Business of Dying: Questioning the Commercialization of Hospice.” J Law Med Ethics, Summer, 224-234.
  • Comondore, V.R., et. al. (2009). “Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis.” Brit Med J, 339.

Topic D: Single payer is good for physicians

  • Talking Point 9: Single payer removes corporate barriers to physicians’ ability to practice medicine.
  • Grumbach, K. & Bodenheimer, T. (1990). “Reins or Fences? A Physicians’ View of Cost Containment.” Health Affairs, Winter, 120-126.
  • Hayes, G.J., Hayes, S.C., & Dystra, T. (1993). “Physicians Who Have Practiced in Both the United States and Canada Compare the Systems.” Am J Public Health, 83, 1544-1548.
  • Talking Point 10: Medical malpractice systems can be harnessed to ensure better quality in single-payer systems. The cost and quantity of medical malpractice suits are decreasing.
  • Schiff, G. (2003). “Medical Malpractice. Health Care Quality and Health Care Reform,” Forum Report #4. PNHP NY Metro.
  • Canadian Health Services Research Foundation. (2006). “Mythbusters: Medical malpractice suits plague Canada.”
  • Adelman, S.H. & Westerlund, L. (2004). “The Swedish Patient Compensation System: A viable alternative to the U.S. tort system?” Bull Am Coll Surg 89(1), 25-30.
  • Talking Point 11: It is a myth that doctors practicing under national health insurance are compensated significantly worse than their American colleagues.
  • How does national health insurance affect physicians’ income?” PNHP document.
  • Duffin, J. “The Impact of Single-Payer Health Care on Physician Income in Canada, 1850-2005.” Am J Public Health, 101(7), 1198-1208.

Topic E: How other countries do it: international health systems

  • Talking Point 12: Every other industrialized, capitalist country has some form of non-profit national health care.
  • Hellander, I. “International Health Systems for Single Payer Advocates.” PNHP Documents.
  • Reid, T.R. (2008). “PBS Frontline Interview with T.R. Reid, Fall 2008.”
  • Case Study: Canada
  • Lasser, K., Himmelstein, D.U., & Woolhandler, S. (2006). “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” Am J Public Health, 96, 1300-1307.
  • Guyatt G.H., et al. (2007). “A systematic review of studies comparing health outcomes in Canada and the United States.” Open Medicine, 1, E27-36.
  • Katz, S.J., Cardiff, K., Pascall, M., Barer, M.L., & Evans, R.G. (2002). “Phantoms in the Snow: Canadians’ Use of Health Care Services in the United States.” Health Affairs, 21(3), 19-31.
  • Case Study: Taiwan
  • Underwood, A. (2009). “Health Care Abroad: Taiwan.” The New York Times Prescriptions Blog, Nov. 3.
  • Cheng, T.M. (2009). “Lessons from Taiwan’s Universal National Health Insurance: A Conversation With Taiwan’s Health Minister Ching-Chuan Yeh.” Health Affairs, 28(4), 1035-1044.

Topic F: Alternative reform proposals

  • Talking Point 13: Alternative proposals for “universal coverage” do not work. State health reforms over the past two decades have failed to reduce the number of uninsured.
  • Himmelstein, D.U. & Woolhandler, S. (2010). “Obama’s Reform: Not Cure for What Ails Us.” Brit Med J, 340, c1778.
  • Angell, M. (2008). “Health Reform You Shouldn’t Believe In.” The American Prospect, April 21.
  • Woolhandler, S., Day, B., & Himmelstein, D.U. (2008). “State Health Reform Flatlines.” Int J Health Serv, 38, 585-592.
  • Himmelstein, D.U., Thorne, D., & Woolhandler, S. (2011). “Medical Bankruptcy in Massachusetts: Has Health Reform Made a Difference?” Am J Med, 124, 224-228.

Topic G: Controlling health care costs

  • Talking Point 14: Computerized medical records and chronic disease management do not save money.
  • Himmelstein, D.U., Wright, A., & Woolhandler, S. (2010). “Hospital Computing and the Costs and Quality of Care: A National Study.” Am J Med, 123(1), 40-46.
  • Geyman, J. (2007). “Disease Management: Panacea, Another False Hope, or Something in Between?” Ann Fam Med, 5, 257-260.
  • Talking Point 15: Immigrants and emergency department visits by the uninsured are not the cause of high and rising health care costs.
  • Mohanty, S., et. al. (2005). “Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis.” Am J Public Health, 95, 1431-1438.
  • Tyrance, P.H., Himmelstein, D.U., & Woolhandler, S. (1996). “US Emergency Department Costs: No Emergency.” Am J Public Health, 95, 1527-1531.
  • Talking Point 16: Co-pays and deductibles are not necessary to control costs and reduce unnecessary care.
  • Goodell, S. & Swartz, K. (2010). “Cost-sharing: Effects on spending and outcomes.” Robert Wood Johnson Foundation. The Synthesis Project, Policy Brief No. 20.
  • Talking Point 17: 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.
  • Light, D.W. & Warburton, R.N. (2005). “Extraordinary Claims Require Extraordinary Evidence.” J Health Econ, 24, 1030-1033.
  • Light, D.W. & Lexchin, J. (2005). “Foreign Free Riders and the High Price of U.S. Medicines.” Brit Med J, 331, 958-60.

Topic H: The public supports single payer, “Medicare for all”

  • Talking Point 18: A majority of physicians (59 percent), and an even higher proportion of Americans (two-thirds), support national health insurance or “Medicare for all.”
  • Carroll, A.E. & Ackerman, R.T. (2008). “Support for National Health Insurance among U.S. Physicians: 5 Years Later.” Ann Intern Med, 148, 566.
  • PNHP. (2007). “PNHP Backgrounder: Recent Public Polls on Single Payer.”
  • Single payer endorsers (HR 676, unions, etc.)

Section III: Tools for Activists

  • Finding your niche in activism
  • Building the movement with public speaking
  • PNHP PowerPoints
  • Media tips
  • Congressional visit “how to” kit
  • Handouts for talks
  • Key Features of Single-Payer National Health Insurance
  • Frequently Asked Questions
  • The case for an Improved Medicare for All
  • PNHP Research
  • Background Fact Sheet
  • Financing single-payer national health insurance: Myths and facts

Find more resources for activists at