The Physicians' Working Group for Single-Payer National Health Insurance*
*Authors: The writing committee for the Physicians' Working Group
for Single-Payer National Health
Insurance included Steffie Woolhandler, MD, MPH
(Department of Medicine, Cambridge Hospital/Harvard
Medical School, Cambridge, Mass), David U. Himmelstein,
MD (Department of Medicine, Cambridge
Hospital/Harvard Medical School, Cambridge, Mass),
Marcia Angell, MD (Department of Social Medicine,
Harvard Medical School, Boston, Mass), and Quentin
D. Young, MD (Physicians for a National Health Program,
Chicago, Ill).
The United States spends more than twice as much on health care as
the average of other developed nations, all of which boast universal coverage.
Yet more than 41 million Americans have no health insurance. Many more
are underinsured. Confronted by the rising costs and capabilities of modern
medicine, other nations have chosen national health insurance (NHI). The
United States alone treats health care as a commodity distributed according
to the ability to pay, rather than as a social service to be distributed
according to medical need. In this market-driven system, insurers and providers
compete not so much by increasing quality or lowering costs, but by avoiding
unprofitable patients and shifting costs back to patients or to other payers.
This creates the paradox of a health care system based on avoiding the
sick. It generates huge administrative costs that, along with profits,
divert resources from clinical care to the demands of business. In addition,
burgeoning satellite businesses, such as consulting firms and marketing
companies, consume an increasing fraction of the health care dollar. We
endorse a fundamental change in US health care—the creation of an NHI program.
Such a program, which in essence would be an expanded and improved version
of traditional Medicare, would cover every American for all necessary
medical care. An NHI program would save at least $200 billion annually
(more than enough to cover all of the uninsured) by eliminating the high
overhead and profits of the private, investor-owned
insurance industry and reducing spending for marketing and other
satellite services. Physicians and hospitals
would be freed from the concomitant burdens and expenses of paperwork
created by having to deal with
multiple insurers with different rules, often designed to avoid
payment. National health insurance would make
it possible to set and enforce overall spending limits for the health
care system, slowing cost growth over the
long run. An NHI program is the only affordable option for universal,
comprehensive coverage.
RELATED ARTICLES IN JAMA
This Week in JAMA
JAMA. 2003;290:707.
FULL TEXT
http://jama.ama-assn.org/cgi/content/full/290/6/707
Universal Health Insurance—Let the Debate Resume
Rashi Fein
JAMA. 2003;290:818-820.
FULL TEXT
http://jama.ama-assn.org/cgi/content/full/290/6/818