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Articles and Reports on Single-Payer


Michael Corcoran. Christian Science Monitor.  September 10, 2009.
"Has Canada Got the Cure?"  Dressel, Holly.  Yes Magazine.  August 4, 2006.

"Pro-single-payer doctors: Health bill leaves 23 million uninsured" Physicians for a National Health Care Program (resolution).  March 22, 2010.
Other reports
Fairness and Accuracy in ReportingStudy: Media Blackout on Single-Payer Healthcare http://www.fair.org/index.php?page=3733
Criticism of PBS Frontline for omitting a discussion of Single Payer

Single-Payer Advocates Have to Get Arrested to Get Heard

Wikipedia entry for “Single Payer”
YES! Magazine

Christian Science Monitor: Single-payer health care: dead in Washington, but alive in the states

By Dylan H. Roby, Gina L. Nicholson, and Gerald F. Kominski
UCLA Center for Health Policy Research
October 2010

Three million commercially insured Californians were enrolled in high-deductible health plans in 2007. High-deductible health plans (HDHPs) have been gaining momentum in the health insurance market as a way to encourage more rational use of health care services. However, HDHPs come with risks.  While the plans offer lower monthly premiums than typical health insurance coverage, they carry much higher deductibles for health care services. For these plans, the average annual deductible for individuals with employer-based insurance is more than $1,800. Studies have shown that significant cost sharing may create disincentives for both necessary and unnecessary care. While individuals with high-deductible plans may be less likely to utilize the emergency room for care, they may also delay necessary treatment or doctor visits.

Another mechanism for improving the affordability of health insurance is the Health Savings Account (HSA), which allows individuals with high-deductible health plans to set aside tax-deductible funds for medical expenses. However, only 23% of commercial HMO and 20% of commercial Kaiser HMO enrollees with HDHPs reported having HSAs as well. Thirty-one percent of commercial PPO enrollees reported having a Health Savings Account in addition to their HDHP.

With the recent passage of health reform, individuals and families will be mandated to have health insurance beginning in 2014. To comply with the mandate and attempt to save money, consumers may purchase plans with lower premiums. However, they could still face high deductibles and cost-sharing requirements, which would harm their ability to access health care.



Single-Payer Health Care:
Dead in Washington, but Alive in the States
Michael Corcoran
Christian Science Monitor
September 10, 2009

President Obama delivered a stirring address to Congress last night, but the federal government's inability to truly overhaul our broken healthcare system – which nowleaves more than 46 million uninsured – is becoming all the more apparent.

Speaking before a joint session of Congress, Obama declared that a public option to compete with private insurers, considered vital by many liberals, was merely a "means to an end," and not essential to healthcare reform. Earlier this summer, a New York Times/CBS poll showed that 72 percent of Americans support a government-run healthcare plan. But Obama's speech last night indicates that while a bill will probably pass, prospects for comprehensive reform – the kind millions of Americans voted for – have dimmed rapidly. Insurance companies, which have given large donations to both political parties, are winning the fight in Washington.

The inability of a popular president with substantial majorities in Congress to pass a progressive health bill is immensely frustrating to healthcare activists, and to all who gave Obama a mandate for change.

But their cause is not lost – they just need a new strategy.

Given the corporate world's disproportionate influence over Washington, it is time to take the fight for public healthcare away from Congress and into statehouses across the country.

State governments are typically far more democratic that the federal government and the public has a much greater ability to penetrate the debate. Moreover, in some states there are already legislatures and grass-roots movements that are working to make a statewide "single-payer plan" – similar to Canada's national health coverage – a reality.

Two state legislatures – Vermont and California – have, in fact, passed single-payer legislation in recent years only to have them vetoed by Republican governors. But California Gov. Arnold Schwarzenegger (R) is ineligible to run for a third term and Gov. Jim Douglas (R) of Vermont has decided not to seek reelection. Either of these states could soon become the first to pass a statewide, public healthcare system that covers everyone.

"I think it makes sense to push for single-payer on a state-wide level," says Dr. Deb Richter, founder of Vermont Health Care for All. "It looks pretty grim in Washington ... so we are mobilizing our forces."

Healthcare activists in Vermont are now advocating for single-payer bills in the Senate and the House and plan to highlight the issue for the 2010 gubernatorial campaign. The Vermont Workers' Center is more than a year into a "Healthcare Is a Human Right" campaign that is releasing reports and organizing rallies all over the state.

"We think this could really happen here," says James Haslam, director of the Vermont Workers' Center. "There is a lot of excitement around this issue. Vermont could become a model for the rest of the country."

Indeed, Vermont may be the state best suited to tackle single-payer. According to a study commissioned by the Vermont Legislature in 2006, Vermont would save $51 million a year if it switched to single-payer. The state is also home to a supportive congressional delegation. Sen. Bernie Sanders, an independent who caucuses with the Democrats, has introduced legislation in the Senate that would enable states to have single-payer systems of their own.

There are also strong prospects for single-payer healthcare in California, where the legislature has twice passed single-payer, only to have it vetoed both times by Governor Schwarzenegger.

But Schwarzenegger has served two terms and will be replaced in 2010, a fact that has emboldened grass-roots activists. "The governor's race is the next stage for the single-payer battle in California," says Chuck Idelson, a spokesman for the California Nurses Association, which has been fighting for single-payer for years. "We need to elect a candidate that is open to single-payer."

The California Nurses Association was also instrumental in lobbying for an amendment, added by Rep. Dennis Kucinich (D) of Ohio to a House version of the federal healthcare reform bill, that would remove potential legal impediments for states to pass single-payer bills by waiving federal exemptions that apply to employer-sponsored health plans from the federal Employee Retirement Income Security Act (ERISA).

"Even if we passed single-payer tomorrow, there would still be a protracted legal battle due to ERISA," Idelson said. "That is why this amendment is so important as we push for single-payer."

But whatever obstacles to statewide single-payer exist, they are small compared to the barriers faced in Washington, where the option was taken off the table before the national conversation began. And with vibrant single-payer movements taking place, not only in Vermont and California, but also New Mexico, Illinois, Pennsylvania, Montana, and elsewhere, it is clear that as long as Washington is impervious to change, the fight for public healthcare must be waged one state at a time.

Michael Corcoran is a journalist who focuses on business, media, and public affairs. He has written for The Nation, The Boston Globe, Extra!, Alternet, Campus Progress, and other publications.


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Has Canada Got the Cure?
Holly Dressel
Yes Magazine
August 4, 2006
Should the United States implement a more inclusive, publicly funded health care system? That's a big debate throughout the country. But even as it rages, most Americans are unaware that the United States is the only country in the developed world that doesn't already have a fundamentally public--that is, tax-supported--health care system.
That means that the United States has been the unwitting control subject in a 30-year, worldwide experiment comparing the merits of private versus public health care funding. For the people living in the United States, the results of this experiment with privately funded health care have been grim. The United States now has the most expensive health care system on earth and, despite remarkable technology, the general health of the U.S. population is lower than in most industrialized countries. Worse, Americans' mortality rates--both general and infant--are shockingly high.
Different paths
Beginning in the 1930s, both the Americans and the Canadians tried to alleviate health care gaps by increasing use of employment-based insurance plans. Both countries encouraged nonprofit private insurance plans like Blue Cross, as well as for-profit insurance plans. The difference between the United States and Canada is that Americans are still doing this, ignoring decades of international statistics that show that this type of funding inevitably leads to poorer public health.
Meanwhile, according to author Terry Boychuk, the rest of the industrialized world, including many developing countries like Mexico, Korea, and India, viscerally understood that "private insurance would [never be able to] cover all necessary hospital procedures and services; and that even minimal protection [is] beyond the reach of the poor, the working poor, and those with the most serious health problems." 1 Today, over half the family bankruptcies filed every year in the United States are directly related to medical expenses, and a recent study shows that 75 percent of those are filed by people with health insurance.2
The United States spends far more per capita on health care than any comparable country. In fact, the gap is so enormous that a recent University of California, San Francisco, study estimates that the United States would save over $161 billion every year in paperwork alone if it switched to a singlepayer system like Canada's.3 These billions of dollars are not abstract amounts deducted from government budgets; they come directly out of the pockets of people who are sick.
The year 2000 marked the beginning of a crucial period, when international trade rules, economic theory, and political action had begun to fully reflect the belief in the superiority of private, as opposed to public, management, especially in the United States. By that year the U.S. health care system had undergone what has been called "the health management organization revolution." U.S. government figures show that medical care costs have spiked since 2000, with total spending on prescriptions nearly doubling.
Cutting costs, cutting care
There are two criteria used to judge a country's health care system: the overall success of creating and sustaining health in the population, and the ability to control costs while doing so. One recent study published in the Canadian Medical Association Journal compares mortality rates in private forprofit and nonprofit hospitals in the United States. Research on 38 million adult patients in 26,000 U.S. hospitals revealed that death rates in for-profit hospitals are significantly higher than in nonprofit hospitals: for-profit patients have a 2 percent higher chance of dying in the hospital or within 30 days of discharge. The increased death rates were clearly linked to "the corners that for-profit hospitals must cut in order to achieve a profit margin for investors, as well as to pay high salaries for administrators."5
“To ease cost pressures, administrators tend to hire less highly skilled personnel, including doctors, nurses, and pharmacists…,” wrote P. J. Devereaux, a cardiologist at McMaster University and the lead researcher. “The U.S. statistics clearly show that when the need for profits drives hospital decisionmaking, more patients die.”
The value of care for all
Historically, one of the cruelest aspects of unequal income distribution is that poor people not only experience material want all their lives, they also suffer more illness and die younger. But in Canada there is no association between income inequality and mortality rates—none whatsoever.
In a massive study undertaken by Statistics Canada in the early 1990s, income and mortality census data were analyzed from all Canadian provinces and all U.S. states, as well as 53 Canadian and 282 American metropolitan areas.6 The study concluded that “the relationship between income inequality and mortality is not universal, but instead depends on social and political characteristics specific to place.” In other words, government health policies have an effect.
“Income inequality is strongly associated with mortality in the United States and in North America as a whole,” the study found, “but there is no relation within Canada at either the province or metropolitan area level -- between income inequality and mortality.”
The same study revealed that among the poorest people in the United States, even a one percent increase inincome resulted in a mortality decline of nearly 22 out of 100,000.
What makes this study so interesting is that Canada used to have statistics that mirrored those in the United States. In 1970, U.S. and Canadian mortality rates calculated along income lines were virtually identical. But 1970 also marked the introduction of Medicare in Canada -- universal, singlepayer coverage. The simple explanation for how Canadians have all become equally healthy, regardless of income, most likely lies in the fact that they have a publicly funded, single-payer health system and the control group, the United States, does not.
Infant mortality
Infant mortality rates, which refl ect the health of the mother and her access to prenatal and postnatal care, are considered one of the most reliable measures of the general health of a population. Today, U.S. government statistics rank Canada's infant mortality rate of 4.7 per thousand 23rd out of 225 countries, in the company of the Netherlands, Luxembourg, Australia, and Denmark. The U.S. is 43rd--in the company of Croatia and Lithuania, below Taiwan and Cuba.
All the countries surrounding Canada or above it in the rankings have tax-supported health care systems. The countries surrounding the United States and below have mixed systems or are, in general, extremely poor in comparison to the United States and the other G8 industrial powerhouses.
There are no major industrialized countries near the United States in the rankings. The closest is Italy, at 5.83 infants dying per thousand, but it is still ranked five places higher.7
In the United States, infant mortality rates are 7.1 per 1,000, the highest in the industrialized world -- much higher than some of the poorer states in India, for example, which have public health systems in place, at least for mothers and infants. Among the inner-city poor in the United States, more than 8 percent of mothers receive no prenatal care at all before giving birth.
Overall U.S. mortality
We would have expected to see steady decreases in deaths per thousand in the mid-twentieth century, because so many new drugs and procedures were becoming available. But neither the Canadian nor the American mortality rate declined much; in fact, Canada's leveled off for an entire decade, throughout the 1960s. This was a period in which private care was increasing in Canadian hospitals, and the steady mortality rates reflect the fact that most people simply couldn't afford the new therapies that were being offered. However, beginning in 1971, the same year that Canada's Medicare was fully applied, official statistics show that death rates suddenly plummeted, maintaining a steep decline to their present rate.
In the United States, during the same period, overall mortality rates also dropped, reflecting medical advances. But they did not drop nearly so precipitously as those in Canada after 1971. But given that the United States is the richest country on earth, today's overall mortality rates are shockingly high, at 8.4 per thousand, compared to Canada's 6.5.
Rich and poor
It has become increasingly apparent, as data accumulate, that the overall improvement in health in a society with tax-supported health care translates to better health even for the rich, the group assumed to be the main beneficiaries of the American-style private system. If we look just at the 5.7 deaths per thousand among presumably richer, white babies in the United States, Canada still does better at 4.7, even though the Canadian figure includes all ethnic groups and all income levels. Perhaps a one-per-thousand difference doesn't sound like much. But when measuring mortality, it's huge. If the U.S. infant mortality rate were the same as Canada's, almost 15,000 more babies would survive in the United States every year.
If we consider the statistics for the poor, which in the United States have been classified by race, we find that in 2001, infants born of black mothers were dying at a rate of 14.2 per thousand. That's a Third World figure, comparable to Russia's.
But now that the United States has begun to do studies based on income levels instead of race, these "cultural" and genetic explanations are turning out to be baseless. Infant mortality is highest among the poor, regardless of race.
Vive la différence! Genetically, Canadians and Americans are quite similar. Our health habits, too, are very much alike -- people in both countries eat too much and exercise too little. And, like the United States, there is plenty of inequality in Canada, too. In terms of health care, that inequality falls primarily on Canadians in isolated communities, particularly Native groups, who have poorer access to medical care and are exposed to greater environmental contamination. The only major difference between the two countries that could account for the remarkable disparity in their infant and adult mortality rates, as well as the amount they spend on health care, is how they manage their health care systems.
The facts are clear: Before 1971, when both countries had similar, largely privately funded health care systems, overall survival and mortality rates were almost identical. The divergence appeared with the introduction of the single-payer health system in Canada.
The solid statistics amassed since the 1970s point to only one conclusion: like it or not, believe it makes sense or not, publicly funded, universally available health care is simply the most powerful contributing factor to the overall health of the people who live in any country. And in the United States, we have got the bodies to prove it.
Holly Dressel was born south of Chicago and lives in Montreal, Quebec. She is a writer/researcher and the best-selling co-author, with David Suzuki, of Good News for a Change and other works.

Pro-single-payer doctors: Health bill leaves 23 million uninsured
For Immediate Release     
March 22, 2010

The following statement was released today by leaders of Physicians for a National Health Program, www.pnhp.org. Their signatures appear below.

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 cancer.

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 demonstrates.

  • 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 2017.

  • 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 high.

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.
Past President
Margaret Flowers, M.D.

Congressional Fellow    

David Himmelstein, M.D.

Steffie Woolhandler, M.D.
Quentin Young, M.D.

National Coordinator
Don McCanne, M.D.

Senior Health Policy Fellow


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.

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