Funding a National Single-Payer System

By Gerald Friedman for Dollars and Sense

Download “Funding a National Single-Payer System” here (.pdf).

Don’t like the Obamacare (or Romneycare) mandate? Single-payer is a viable—and more redistributive—alternative.

“The Expanded & improved Medicare for all act” (hr 676) would establish a single authority responsible for paying for health care for all Americans. Providing universal coverage with a “single-payer” system would change many aspects of American health care. While it would raise some costs by providing access to care for those currently uninsured or under-insured, it would save much larger sums by eliminating insurance middlemen and radically simplifying payment to doctors and hospitals. While providing superior health care, a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits. A single-payer system would also make health-care financing dramatically more progressive by replacing fixed, income-invariant health-care expenditures with progressive taxes. This series of charts and graphs shows why we need a single-payer system and how it could be funded.


  1. Roger Bird on April 16, 2012 at 9:22 pm

    Yes! We should be ashamed of the state of our health care system. We need a single payer system!

    • Cypher on April 24, 2012 at 1:19 pm

      I hope this will happen in my lifetime but the American system is so totally corrupt with money at the very core that I’m not optimistic.

      • David Mintz on April 24, 2012 at 1:28 pm

        Precisely. That’s why we must abandon the pro-Obama, quintessentially liberal delusion that incremental reform will somehow, someday result in a more equitable society; the delusion that Republicrats serve the interests of anyone other than the oligarchy. Nothing less than a radical restructuring will do it. A socialist revolution, if you will.

        • gopher on April 24, 2012 at 3:48 pm

          It is not that Obama doesn’t want single payer, he wants it, but sadly he hasn’t the courage to issue an Executive Order. Maybe if he gets a second term, he will sign into law several executive orders he really wants. But he better hurry. Congress’s credibility is nil now.

          • Aquifer on April 24, 2012 at 9:19 pm


            Obama took single payer off the table before he even got the Dem nomination, he had been bought of by insurance companies, big pharma, Wall St. etc and he has never looked back.

            If you want single payer go with Jill Stein – the Mass MD running for Pres. on the Green Party line – that is the only way you will get it ….


      • j magee on April 24, 2012 at 3:56 pm

        Let’s acknowledge that Obama has been a mega whore and forget about his brand of “HOPE” re:(hopeless) and step up to the plate and demand what should have been our’s from the start…It would be great to see all the corperate sludge buble to the serface…Single Payer Health…NOW…

      • Dr. Dan on April 25, 2012 at 10:16 pm

        My lifetime? How long is that? Darned if I know. I have some symptoms of a medical condition that could cause me to drop dead by the time you read this…or it could be other things that are not so serious. How could I know? An MRI. But no insurance, no moohlah to pay for it…

  2. Lily Allin on April 24, 2012 at 2:00 pm

    Yes, single payer is the answer, but what hope is there that it will get through through the Congress? People are dying now because they can’t get access to health care. If death can’t get politicians to move on this and the medical industrial complex is so entrenched, I don’t see things changing anytime very soon. Single payer is the answer, but it is only pie in the sky because politicians don’t give a rip.

  3. Zac Pitts on April 24, 2012 at 2:02 pm

    When the policy makes become as altruistic as the nurses and doctors in the healthcare workforce we might see this happen… So in other words I am not optimistic. Ironically enough, our best hope is for the system to go bust and then maybe the incredibly dense policy makers all across the country will then realize a change is needed… but again I am not optimistic.

  4. Tom Hagan on April 24, 2012 at 2:04 pm

    “…$570 billion now wasted on administrative overhead and monopoly profits.”

    It is wrong to put it this way. It’s not as though intelligent elimination of wasteful overhead could be done, or that profits are excessive. It’s that private health insurance, unlike other forms of private insurance, achieves its minimum total cost when tons of money are spent on “medical loss prevention” – treatment denials.

    The famous “invisible hand”, which free marketers think would reduce our healthcare bill, can’t do so – for the simple reason it has already reduced total cost to a minimum.

    Unfortunetely for us all, that minimum occurs when treatment denials consume 31% of premium costs. We need single payer.

  5. Vic Anderson on April 24, 2012 at 3:02 pm

    And STOP The DEM Bush WARS!

  6. angela on April 24, 2012 at 3:51 pm

    yes, out in the streets, no less apparently….dem and repub=same ol stuff. why do we not have another dem challenge obama? i don’t understand why we think we just have to keep him in the slot. and by the way, who in the hell wants american medicine? i mean i would only want single payer if it included naturopath dr’s and the like. dr’s are truly ignorant of health. so don’t forget that in the topic.

    • KenS on April 24, 2012 at 6:42 pm

      Angela is a truth-teller. Most of what ails us is caused by sitting in front of the boob tube to ensure that the crap we eat, like poisoned dead animals, has a chance to turn us into poisoned dead animals; and Angela’s “dr’s …truly ignorant of health” prescribe toxic pharmaceuticals to hasten the process. Meanwhile, the health insurance vultures and their parasitic stockholders grimly reap their profits, except for the scraps they throw to corrupt politicians

  7. bill on April 24, 2012 at 4:04 pm

    It is sad, I had to go outside of the country to receive treatment for my skin cancer because I am not insured. Single Payer is an urgent necessity in our country, we, the 99%, are suffering because our health care system is only for the 1%. If you have an insurance, at the end of any catrastrofic illness you do not know if you are going to die because the illnes or the bill in your mailbox, sad.

  8. bill on April 24, 2012 at 4:06 pm

    Lastly, I will be supporting Single payer until the last minute of my life.

  9. Peggy on April 24, 2012 at 4:29 pm

    There are several things we must do before Single Payer is even possible. First, we must get the money out of our elections. Then we must elect as many Progressive candidates that we can, candidates just like Bernie Sanders. Then we must revisit the filibuster that the Republicans have been using to prevent any Progressive legislation being passed. Then, perhaps we can get Single Payer passed. But, sadly, not till then.

  10. Deborah Schumann, M.D. on April 24, 2012 at 6:26 pm

    Bravo, Gerald Friedman. We need economists to analyze the reality of spending in the U.S. “health care system”. Unfortunately, politics and public policy are not decided on the basis of economic FACTS. Furthermore, Republicans are genetically opposed to CHANGE. That also means that they don’t believe that the future should be better than the present. Maybe we can convince them that the QUALITY OF CARE in this country is deteriorating because of the profit motive and the WASTE OF RESOURCES. But I doubt it. When a MAJORITY of Americans can’t access health care either because they can’t afford it or because the providers are gone, maybe we will elect some officials to DO THE RIGHT THING WITH SINGLE PAYER. I practiced medicine from 1975 to 2005 and saw nothing but deterioration of the system as a whole, so I’m not holding my breath. Meanwhile, I am so happy to be eligible for Medicare NOW. It isn’t perfect because it has been damaged by the for-profit system, but it sure is better than what I have now in the individual market.

    • Aquifer on April 24, 2012 at 9:26 pm

      Dr. Schumann,

      As a retired physician, i concur with your assessment of the system, however i would add Dems as “co-conspirators” in the process. That is why i am on board with Dr. Jill Steins campaign for Pres. I invite you and all to join – we can do this, we can get there …

  11. Bud on April 24, 2012 at 7:43 pm

    What seems to be missing from many of your comments is reality.
    The Insurance Industry is who you are mad at NOT the president. Obama and none of the former administrations had any power over this issue. They can not do anything by executive order and, although Obama has done a lot to help the military health care, the insurance industry controls the Congress and that is as far as anything that would help this issue has ever gone. The health care bill did a lot to fix some of the issue but it seems as typical greedy American Fake citizens everyone wants it all and they want it NOW. Grow up and get in the real world where things dont get done until YOU do them. Like stop voting for the same arseholes that you always seem to reelect. Stop bitching at folks who have nothing to do with the issue. Storm the Insurance Industry Castles and demand they end their rein of terror over this nation…stop paying them for insurance they will eventually deny you. for Obama score card on promises kept…many. to elect a candidate that isnt connected to any corporation…especially the insurance industry

  12. Harry on April 24, 2012 at 10:13 pm

    single payer… ! Yes !

  13. Harry on April 24, 2012 at 10:14 pm

    single payer is the way.

  14. David Greenstein O.D. on April 25, 2012 at 12:19 am

    It has been obvious to me for a long time that we need health care for all and not insurance companies for all. If we extended Medicare to all, younger people who need medical services less than older people will make Medicare more cost effective and will save incredible amounts of money that we are presently spending to cater to the insurance schemes that we are forced to deal with now. Single payer is the obvious solution to the healthcare crisis. Other countries have shown us the way. If we don’t make the smart change we may go bankrupt.

  15. Mike Pollock on April 27, 2012 at 10:37 pm

    Those of you who are doubting President O’bama’s commitment to reform need to take a deep breath and think about the possibility of having any meaningful reform with President Romney. It’s not a perfect world and President O’bama knows that. So back off, unite and fight to get him re-elected.