A false promise of reform

Pro-single-payer doctors: Health bill leaves 23 million uninsured

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


  1. Milagros Garcia Villamil Esq. NPR on March 22, 2010 at 3:28 pm

    One of the saddest things about this healthcare bill is that it was not thought out with those in need most!! in mind.

    This is a corporate bill designed to provide the best care for the dandys on Capital hill including the POTUS.. Thereafter, what poor people and working people will get is watered down leftovers provided by those who do not speak English and have a dislike for those who are either poor or look like myself.
    Some of us, esp the young and older people will become victims of TUSKEGEE like studies..Thse medical prof (so called) are already scouting poor rural communites for the best set up.. IE Adel Ga, Springfield Mass New bedfored Mass pohokee fla, Sumpter SC, Algiers LA, small rural towns with huge pop of Spanish speakers ie New mex, Ariz, Nev, Tx, Okla Ca

    I am a prof with two careers about to retire. There is no way that i need more help and if something catasprophic happens i will fly to Cuba.
    However my concerns are for the elderly of all races, the children disabled and those with little or no insurance working for min wage..How is this universal health care?

    Now please do not get me wrong.i love Pres Obama, however i do not DO NOT!! buy his rational.He is wrong and his EGO has him backed int o a corner..having said this..I am just waiting to find out how much he gave away to get this far and what else does he have to give the Senate.

  2. elyse on March 22, 2010 at 4:18 pm

    Yes, what you say is compelling, but given that single payer would not pass in this Congress, what else could we have done for now? Many people are a little better off.

    I support single payer, so I will look forward to reading about Health Care Now’s next actions steps.

  3. Barbara on March 23, 2010 at 5:53 pm

    Thank you all for your efforts. I am with you, and so are millions of other individuals. There is no end to this cause until a single-payer system cares, unconditional, for every individual in the country. The White House was handed a grand opportunity, by the people of this country, to lead us in the elevation of ethics and purpose in the realm of human affairs, but it failed miserably. This bill is not a step toward single payer, but, rather, a roadblock. Still, there is no choice but to use this as a catalyst and continue on, in the footsteps of those before us who took the words ‘We the People’ to heart, to mind and to the streets. My best to you all.

  4. Giovanna Lepore on March 23, 2010 at 9:00 pm

    Why don’t we take a collective pledge today right now not to cooperate with such a travesty of a law? Imagine masses of people simply refusing to support the private health “care” insurance industry.