Archived: America Needs a Single Payer Health Care System


More than a year after President Barack Obama signed the Patient Protection and Affordable Care Act into law, our nation’s health care delivery and coverage remain the disgrace of the industrialized world. There are more than 50 million uninsured Americans. Even if the health care overhaul works as planned, 23 million Americans will still lack health insurance in 2019.

The new norm is underinsurance. About 40 percent of us go without needed care because we can’t afford it. The health care law won’t change that, even once it’s completely phased in. Our plague of medical bankruptcies will continue too.

For unions, bargaining for health care is getting tougher as employers demand cuts and shift more costs to workers. Negotiations over better health coverage will become almost impossible when the excise tax on health benefits begins in 2018.

Many who saw the reform bill as “the best we could get” are disappointed that support for it hasn’t grown. The truth is that most people agree on the reform law. They love the parts that block insurance companies from denying coverage and care. They hate the parts that give away our tax dollars to insurance companies. They hate the mandate that will force everyone to buy insurance from the very companies whose profit motive is the source of most of our health care system’s problems. They hate the escalating costs of insurance and care.

Only a single payer system can bring us the parts we love and do away with the parts we hate. It would essentially expand Medicare coverage to all Americans, providing 100 percent guaranteed coverage regardless of employment status or pre-existing conditions. That may sound expensive, but it’s not. The “potential savings on paperwork, more than $400 billion per year, are enough to provide comprehensive coverage to everyone without paying any more than we already do,” according to Physicians for a National Health Program.

Every pro-patient measure in the law brings an ugly backlash from insurance companies, because they want to remain in the driver’s seat. For example, the act says children who have been sick can’t be denied coverage. Insurers have responded by refusing to sell child-only policies. The act says there must be minimal standards of coverage. Yet hundreds of companies have obtained waivers after threatening to drop coverage altogether.

The legislation is designed to expand Medicaid as the main way for states to cover more people. It prohibits states from dumping people currently covered. Yet with state budgets in crisis, Medicaid is under the knife. Arizona plans on dumping 250,000. Many states propose increasing patient co-pays, thus damaging the ability of patients to find doctors and fatally undermining rural hospitals.

Some assert that healthcare reform just isn’t working. Yet. Give it 10 years, and all will be fixed.
But our new health law is anchored on the private insurance industry — and that’s its fatal flaw. The insurers inflict enormous and unnecessary administrative costs on our system. This amounts to hundreds of billions of dollars every year and condemns us to spend about double, per capita, what other nations spend on health care.

Health care advocates must move beyond the health care reform law. Rep. John Conyers (D-MI) has reintroduced H.R. 676, the Expanded and Improved Medicare for All Act, which would bring all medically necessary care to everyone while assuring choice of physician. The bill is based on sound single-payer policy and progressive public funding.

If every other industrialized nation can make health care a human right, we can do it too. Our challenge is to pass effective legislation despite the powerful private health insurance companies and other corporations whose influence often trumps democracy.

First, we must have a powerful movement. We can’t build it around a shriveled dream. Only single payer, with its bolder promise of social justice, can inspire that movement.

Kay Tillow is the coordinator of the All Unions Committee for Single Payer Health Care, which builds union support for H.R. 676. She lives in Louisville, Kentucky.

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  1. Open (not “free”) Market Solution:

    1. Reform Medicare and Medicaid to empower individuals to allocate the funds, up to a means tested limit, after which catastrophic insurance kicks in. Monthly allocations to these accounts will have a mandatory % go to a catastrophic insurance pool.
    1. Allow tax free premiums for individuals.
    2. Allow insurance companies to cross state lines to compete in every county.
    3. Allow Health Savings Accounts which can be invested to further incentivize self-insurance.

    But of course, power-hungry socialists and infantile egalitarians like yourselves do not see merit in competiition and choice. You see private citizens a children to be marched around and given everyhting in perferct equality. Well you can roll up your coercive plan into a tight scroll and go f–k yourselves with it.

  2. Wayne Piccin on

    Healthcare reform is not working because the Affordable Care Act will not rein in the steep rise in health care costs. But a single payer system and eliminating insurance companies is not the answer. Any attempts in that direction will only increase the number of people against reform.
    We need malpractice reform. Medical record systems must be based on universal computer standards and shared by all the patient’s caregivers. We need more attention to preventive medicine and less fee for services. And finally the healthy have to bear more of the cost for insuring the more seriously ill so that when they become seriously ill, teh funds will be there to cover them.

  3. Concur with Kay, but also: I do not like the idea of increasing the cost to the taxpayers to expand Medicaid. Medicaid is another medical coverage program we have to pay for but which we cannot use. I prefer National Healthcare (e.g. expand Medicare to cover everybody) because those paying for it could also use it. Let’s throw the Medicaid dollars into the funding pot to help pay for a good National Healthcare Program.

  4. I have long argued for a single payer system, like those in every other industrialized country. Simply extend Medicare to everyone, paid for by national taxes; leave the states out of it, and especially take it away from the for-profit insurance companies, which make their money by denying coverage to the sick. To me, making profits from other peoples’ misfortune is unethical and un-American. Doctors and their staffs would have so much less paperwork to do if they had only one set of forms to fill out for each patient or treatment they provide.
    I agree that something must be done about malpractice suits, such as limiting awards to $250,000 or so, adjusted each year for inflation. They would then be able to practice medicine professionally, without having to order more procedures and drugs than necessary.

  5. Jane Jensen on

    Single payer is the only fair plan for seniors, minor children & all adults.

    It will save so much money & give good care to everyone.

  6. It is universally acknowledged that health care is too expensive in America, leading to under-insured or uninsured. The arguments to socialize or allow ti to remain a private industry are compelling, and it is an interesting crisis to watch. However, I am interested in seeing ways to reduce costs first. If you take a multi-billion costing industry and divide it up among taxpayers, you will have a difficult time convincing them to do it. If healthcare costs are first reduced, and then made public, it may be another story. One of the leading things that contributes to high health care costs for all are the costs resulting in defensive medicine practices from physicians. The threat of medical malpractice insurance claims is enough to drive some doctors to order unnecessary tests and procedures, of which the costs are then deflected. Until we provide doctors with enough job and legal security to allow them to practice freely without fear, then there is no sense in talking about attempting to lower health care costs.

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