Proposal
of the Physicians' Working Group for Single-Payer National Health Insurance
Executive
Summary
To view the proposal as published in JAMA, (August
13, 2003) please click here. Adobe
Reader is needed to open the full report.
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 over 39 million Americans have no health
insurance whatsoever, and most others are underinsured, in the sense that they
lack adequate coverage for all contingencies (e.g., long-term care and prescription
drug costs).
Why is the U. S. so different? The short answer is that we
alone treat 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 our market-driven system, investor-owned firms 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,
which, 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 America's health care - the
creation of a comprehensive National Health Insurance (NHI) Program. Such a program
- which in essence would be an expanded and improved version of Medicare - would
cover every American for all necessary medical care. Most hospitals and clinics
would remain privately owned and operated, receiving a budget from the NHI to
cover all operating costs. Investor-owned facilities would be converted to not-for-profit
status, and their former owners compensated for past investments. Physicians could
continue to practice on a fee-for-service basis, or receive salaries from group
practices, hospitals or clinics.
A National Health Insurance Program would
save at least $150 billion annually by eliminating the high overhead and profits
of the private, investor-owned insurance industry and reducing spending for marketing
and other satellite services. Doctors 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 rules designed to avoid payment. During the transition
to an NHI, the savings on administration and profits would fully offset the costs
of expanded and improved coverage. NHI would make it possible to set and enforce
overall spending limits for the health care system, slowing cost growth over the
long run.
A National Health Insurance Program is the only affordable option
for universal, comprehensive coverage. Under the current system, expanding access
to health care inevitably means increasing costs, and reducing costs inevitably
means limiting access. But an NHI could both expand access and reduce costs. It
would squeeze out bureaucratic waste and eliminate the perverse incentives that
threaten the quality of care and the ethical foundations of medicine.
