|Pro-single-payer doctors: Health bill leaves 23 million uninsured
A false promise of reform
The following statement was released today by leaders of Physicians
for a National Health Program, www.pnhp.org. Their signatures appear
AS MUCH AS WE would like to join the celebration of the House's
passage of the health bill last night, in good conscience we cannot.
We take no comfort in seeing aspirin dispensed for the treatment of
Instead of eliminating the root of the problem - the profit-driven,
private health insurance industry - this costly new legislation will
enrich and further entrench these firms. The bill would require
millions of Americans to buy private insurers' defective products, and
turn over to them vast amounts of public money.
The hype surrounding the new health bill is belied by the facts:
About 23 million people will remain uninsured nine years out. That
figure translates into an estimated 23,000 unnecessary deaths annually
and an incalculable toll of suffering.
Millions of middle-income people will be pressured to buy commercial
health insurance policies costing up to 9.5 percent of their income
but covering an average of only 70 percent of their medical expenses,
potentially leaving them vulnerable to financial ruin if they become
seriously ill. Many will find such policies too expensive to afford
or, if they do buy them, too expensive to use because of the high
co-pays and deductibles.
Insurance firms will be handed at least $447 billion in taxpayer money
to subsidize the purchase of their shoddy products. This money will
enhance their financial and political power, and with it their ability
to block future reform.
The bill will drain about $40 billion from Medicare payments to
safety-net hospitals, threatening the care of the tens of millions who
will remain uninsured.
People with employer-based coverage will be locked into their plan's
limited network of providers, face ever-rising costs and erosion of
their health benefits. Many, even most, will eventually face steep
taxes on their benefits as the cost of insurance grows.
Health care costs will continue to skyrocket, as the experience with
the Massachusetts plan (after which this bill is patterned) amply
The much-vaunted insurance regulations - e.g. ending denials on the
basis of pre-existing conditions - are riddled with loopholes, thanks
to the central role that insurers played in crafting the legislation.
Older people can be charged up to three times more than their younger
counterparts, and large companies with a predominantly female
workforce can be charged higher gender-based rates at least until
Women's reproductive rights will be further eroded, thanks to the
burdensome segregation of insurance funds for abortion and for all
other medical services.
It didn't have to be like this. Whatever salutary measures are
contained in this bill, e.g. additional funding for community health
centers, could have been enacted on a stand-alone basis.
Similarly, the expansion of Medicaid - a woefully underfunded program
that provides substandard care for the poor - could have been done
separately, along with an increase in federal appropriations to
upgrade its quality.
But instead the Congress and the Obama administration have saddled
Americans with an expensive package of onerous individual mandates,
new taxes on workers' health plans, countless sweetheart deals with
the insurers and Big Pharma, and a perpetuation of the fragmented,
dysfunctional, and unsustainable system that is taking such a heavy
toll on our health and economy today.
This bill's passage reflects political considerations, not sound
health policy. As physicians, we cannot accept this inversion of
priorities. We seek evidence-based remedies that will truly help our
patients, not placebos.
A genuine remedy is in plain sight. Sooner rather than later, our
nation will have to adopt a single-payer national health insurance
program, an improved Medicare for all. Only a single-payer plan can
assure truly universal, comprehensive and affordable care to all.
By replacing the private insurers with a streamlined system of public
financing, our nation could save $400 billion annually in unnecessary,
wasteful administrative costs. That's enough to cover all the
uninsured and to upgrade everyone else's coverage without having to
increase overall U.S. health spending by one penny.
Moreover, only a single-payer system offers effective tools for cost
control like bulk purchasing, negotiated fees, global hospital
budgeting and capital planning.
Polls show nearly two-thirds of the public supports such an approach,
and a recent survey shows 59 percent of U.S. physicians support
government action to establish national health insurance. All that is
required to achieve it is the political will.
The major provisions of the present bill do not go into effect until
2014. Although we will be counseled to "wait and see" how this reform
plays out, we cannot wait, nor can our patients. The stakes are too
We pledge to continue our work for the only equitable, financially
responsible and humane remedy for our health care mess: single-payer
national health insurance, an expanded and improved Medicare for All.
Oliver Fein, M.D.
Garrett Adams, M.D.
Claudia Fegan, M.D.
Margaret Flowers, M.D.
David Himmelstein, M.D.
Steffie Woolhandler, M.D.
Quentin Young, M.D.
Don McCanne, M.D.
Senior Health Policy Fellow
Mark Almberg, PNHP, (312) 782-6006, firstname.lastname@example.org
Physicians for a National Health Program (www.pnhp.org) is an
organization of 17,000 doctors who support single-payer national
health insurance. To speak with a physician/spokesperson in your area,
visit www.pnhp.org/stateactions or call (312) 782-6006.