Calls for Single-Payer System Grow Louder

A cofounder and board member of Physicians for a National Health Program, says "many patients will die because they can't get the preventive or primary care they need."

Senator Bernie Sanders has made it a cornerstone of his campaign.

Vermont tried and failed to pass it.

In November Colorado voters will put the matter to a vote.

Now physicians are chiming in.

In an editorial and proposal published recently in the American Journal of Public Health, 2,231 physicians called for a single-payer national health program to replace the current private insurance model of financing healthcare. 

While the Patient Protection and Affordable Care Act has increased access to healthcare services for millions of people, many physicians still have grave concerns over patients' ability to get the care they need, says Steffie Woolhandler, MD, a co-author of the editorial and proposal.  

Woolhandler is a cofounder and board member of Physicians for a National Health Program, a non-profit advocacy group that supports single-payer national insurance.

She is also a practicing primary care physician, a professor in the CUNY School of Public Health at Hunter College, an adjunct clinical professor at Albert Einstein College of Medicine, and lecturer in medicine at Harvard Medical School.

The ACA Has Not Done Enough

Physicians are supporting a single-payer system, Woolhandler says, because they know that "lives are literally at stake."

"I think doctors are seeing lots of patients who can't get the care they need despite improvements that have come from the ACA. There are still 26 million to 30 million uninsured people, depending on the source, and there is no prospect of that going down because the ACA is almost fully implemented.

Many patients will die because they can't get the preventive or primary care they need," she says.

"Doctors see this in their practice. They also see patients all the time who are underinsured. They have insurance but still can't afford the care they need… Many doctors feel the ACA has not solved the problems around access to care."

Among the main points outlined in the national health program are:

• Patients could choose to go to any doctor and hospital.
• Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHP to cover all operating costs. 
• Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.
• The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes that would be fully offset by reductions in premiums and out-of-pocket spending. 
• Co-pays and deductibles would be eliminated.

Having a single-payer system to cover all Americans for all medically necessary care would also ultimately cut the nation's healthcare spending by as much as $500 billion per year, Woodhandler says, because of reductions in administrative expenses.

"Once you have a single-payer system, you have to decide how much you are willing to spend. Our group would say, at least initially, to spend what we are spending now for the first few years to avoid disruption, but over time there would be huge administrative savings," she says. 

The United States Isn't Canada

Critics of a single-payer healthcare system often cite problems such as long wait times when opposing the new approach to paying for care. 

In a recent blog post, Sally C. Pipes, president, chief executive officer, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute, offers reasons why the United States should not move towards a single-payer system. 

"Take Canada. As someone who was born there, I can tell you firsthand that Canada's single-payer health system is the last thing the United States needs. Canadians looking for treatment must wait for care, even if they're in desperate need. Alberta Health Services, for example, reports that 90% of patients who need back surgery have to wait up to almost nine months," she writes.

"The Fraser Institute, a Canadian think tank, calculates that residents of our northern neighbor have to wait an average of two months to get an MRI—and almost a year if they need orthopedic surgery. One in three is waiting to see a primary care doctor."

While Woolhandler acknowledges some of the issues faced by Canadians trying to access healthcare services, she says it relates mainly to the fact that Canada spends 40% less per capita on healthcare than does the United States. 

"If we take their system and spend more, there don't have to be wait times. In most of western Europe there are no wait times, so it is not a necessary component of national health insurance. It is a function of how much money we are willing to spend," she says. 

"If we want a very thrifty system, we will have wait times. If we want to spend the kind of money the U.S. has historically spent, there don't have to be wait times. I think we could have a 'Canada Deluxe' version where there is universal coverage but with higher levels of spending on high tech services and the like."

A 'Strictly Nonpartisan' Issue

The idea of a single-payer program has been a political hot potato for decades and has gained attention recently thanks to Bernie Sanders' call for what he refers to as "Medicare for All." 

"Healthcare must be recognized as a right, not a privilege. Every man, woman, and child in our country should be able to access the healthcare they need regardless of their income. The only long-term solution to America's healthcare crisis is a single-payer national healthcare program," Sanders says on his website. 

However, the new physicians' proposal is "strictly nonpartisan," says the Physicians for a National Health Program. 

And while the organization welcomes support from high-profile politicians, it will continue to do its work regardless of which way the political winds may blow, Woolhandler says. 

"Certainly having prominent public figures support a single-payer system is very helpful and something we welcome… Sanders is the main person now in the public sphere to support it, and it is obviously good for getting the word out and creating a public discussion and dialogue," she says. 

"Our members are writing op-eds in newspapers, speaking at community meetings and grand round meetings. We're soliciting more physician signatures and working with large medical student organizations to work with the next generation of physicians to engage them in this project."

"Our strategy is to be as vocal as possible in as many forums as possible. People are very happy to hear from doctors about policy issues when they see the doctors are advocating for public health."