Single-Payer Talking Points & Why Mandate Plans Won’t Work

The New York City Chapter of Physicians for a National Health Program has put together some “talking points” for making the single payer “expanded and improved Medicare for All” argument.

1. Americans are afraid that they can’t afford to get sick. Those of us with insurance are paying more and more of the premium and more out of pocket as well. Studies show further that we face bankruptcy if we get sick. Many among us have to choose between paying for medicine and paying for food and housing. And with the recent economic downturn, the ranks of those without insurance are growing.

2. A majority of physicians (59 percent), and an even higher proportion of Americans (62% or more) support single payer national health insurance or “Medicare for all”. In spite of this, all we are hearing about today are mandate plans that would require everyone to buy the same private insurance that is already failing us. These proposals don’t regulate insurance premiums, they don’t keep the insurance companies from refusing to pay many of our bills, and they don’t improve the insurance we now have. Some offer a “public option,” but this will quickly become too expensive as the sick flee to the public sector as private insurers avoid them, abandon them, or make it too difficult for them to get their bills paid.

3. These mandate proposals won’t work, either to expand coverage or to contain costs. Plans like these have been tried in many states over the past two decades (Massachusetts, Tennessee, Washington State, Oregon, Minnesota, Vermont, Maine). They have all failed to reduce the number of uninsured or to contain costs.

4. These mandate plans will add hundreds of billions of dollars to the nation’s health care costs. In this economic downturn, we need assure health care for all without adding to the nation’s cost and the government’s deficit. The bottom line is: these proposals don’t reform the system – they just add to it.

5. As long as we continue to rely on private for-profit insurers, universal coverage will be unaffordable. Their administrative costs consume nearly one-third of our health care dollar. We will never have enough money to provide everyone with decent care until we eliminate private insurance with its enormous waste and inadequate coverage. And we will never be able to keep costs down and get the care we need as long as the wasteful and unnecessary insurance companies stand between us and our doctors.

6. Every other industrialized country has some form of universal health care. None uses profit-making, investor-owned insurance companies like ours to provide health care for all their people.

7. We have an American system that works. It’s Medicare. It’s not perfect, but Americans with Medicare are far happier than those with private insurance. Doctors face fewer hassles in getting paid, and Medicare has been a leader in keeping costs down. We should improve and expand Medicare to cover everyone.

8. A single payer “Medicare for All” System is embodied in H.R. 676, sponsored by Rep. John Conyers and 92 other Members of Congress. It would have:

  • Automatic enrollment for everyone
  • Comprehensive services covering all medically necessary care and drugs
  • Free choice of doctor and hospital, who remain independent & negotiate their fees and budgets with a public or non-profit agency.
  • Public or non-profit agency processes and pays the bills.
  • Entire system financed through progressive taxes.
  • Help job growth and the entire U.S. economy by removing the burden of health costs from business.
  • Cover everyone without spending any more than we are now.

9. The growth in health care costs must be addressed if any proposal is to succeed.

Single payer offers real tools to contain costs: budgeting, especially for hospitals, planning of capital investments, and an emphasis on primary care and coordination of care.

Mandate plans offer only hopes: competition among insurance companies, computerization, chronic disease management. Competition among the shrinking number of insurance companies has already failed to contain costs and, in the absence of single payer and reformed primary care, computerization and chronic disease management will raise costs, not lower them.

10. Single payer Medicare for All is the right answer:

It is right on choice. It provides free choice of doctor and hospital, the choice Americans want and value. In mandate plans, we lose those choices.

It is right on efficiency. Single payer would slash administrative costs and can promote efficient primary care, management of chronic diseases, and the expanded use of electronic medical records.

It is right on accountability. It will be a public, non-profit system that will respond to what doctors and their patients need, not what corporate executives and their stockholders want.

References by Number:
1. “Illness and Injury as Contributors to Bankruptcy,” D. Himmelstein et al, Health Affairs Web Exclusive, February 2, 2005.

2. Carroll, A., Ackerman, R., “Support for National Health Insurance Among U.S. Physicians: 5 Years Later,” Annals of Internal Medicine, 148(7), April 1, 2008; ABC News/Washington Post, Oct. 9-13, 2003, Associated Press/Yahoo News Poll, Dec. 14-20, 2007.

3. S. Woolhandler, et al “State Health Reform Flatlines,” International Journal of Health Services, 2008; Marcia Angell, “Health Reform You Shouldn’t Believe In,” The American Prospect, April 21, 2008.

5. S. Woolhandler, et al “Costs of Health Care Administration in the U.S. and Canada,” New England Journal of Medicine, Sept. 21, 2003; J.G. Kahn et al, “The Cost of Health Insurance Administration in California: Estimates for Insurers, Physicians, and Hospitals,” Health Affairs, 2005.

6. Reid, T.R., “Sick Around the World,” PBS, April 15, 2008; Thompson, S., Mossialos, E., “Private Health Insurance and Access to Health Care in the European Union,” Euro Observer, Spring 2004.

8. United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act), H.R.676, ; “Health Care for All Californians Act: Cost and Economic Impacts Analysis,” The Lewin Group, January 2005

This article is from the Daily Kos.


  1. Peter Christiansen on December 13, 2008 at 5:58 pm

    Virtually all economists agree it is imperative that state and local governments beging spending money immediately to head off a depression and the adoption of single-payer would free up billions of dollars in health care costs currently being shouldered by state and local governments. Single-payer is a “twofer”: It cuts health care cost in half while covering all Americans, and it would be a huge stimulous to the economy.

  2. Peter Christiansen on December 13, 2008 at 5:59 pm

    The U.S. is the only first world country in which unemployment is a life threatening condition.