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Who is PNHP?
Physicians for a National Health Program is a non-profit research and education organization of 20,000 physicians, medical students and health professionals who support single-payer national health insurance.
Beyond the Affordable Care Act
A Physicians’ Proposal for Single-Payer Health Care Reform
Summary
The Physicians’ Proposal for Single-Payer Health Reform was drafted by a working group of 39 physicians and has been endorsed by more than 2,231 other physicians and 149 medical students. The most important feature of the Physicians’ Proposal is the removal of all financial barriers to medical care.
The plan would save enough on administrative overhead to provide comprehensive coverage to the uninsured and to upgrade coverage for everyone else, thus requiring no increase in total health spending. In addition, it would put in place effective mechanisms to control costs, lowering the rate of medical inflation and making the health system sustainable for future generations. Significantly, it would restore free choice of clinician and hospital to all Americans.
Access
Every resident of the U.S., including all immigrants, would be covered for all necessary medical care. Patients would receive a National Health Program (NHP) card entitling them to care at any hospital or doctor’s office. Medical bills for covered services would generally be eliminated, although the NHP might seek reimbursement from other national health insurance systems for care provided to tourists who fall ill while visiting the U.S.
Benefits
Coverage would include outpatient and inpatient medical care as well as rehabilitation, mental health care, long-term care, dental services, and prescription drugs. In effect, the plan improves on traditional Medicare’s benefits and expands coverage to all Americans. It would eliminate premiums, co-pays, deductibles, and co-insurance.
Administration / Administrative Savings
The program would be federally financed (like Medicare) and administered by federal, state and regional boards. Private insurance which duplicates NHP coverage would be prohibited. Replacing the complex and redundant private insurance bureaucracy with a streamlined single-payer program would greatly simplify administration for doctors and hospitals. Overall, cutting administrative spending to Canadian levels would save about 15 percent of national health expenditures, freeing up nearly $500 billion annually for expanded and improved coverage.
Effective Cost-Controls
The initial increase in government costs would be fully offset by savings in premiums and out-of-pocket costs. According to estimates from the Government Accountability Office, the Congressional Budget Office, and several private consulting firms, the administrative savings possible with a single payer are enough to cover all of the uninsured and to upgrade coverage for the under-insured without any increase in total health spending.
Future costs increases would be contained by the NHP’s ability to set and enforce overall spending limits, negotiate prices, and improve health planning.
Hospitals and other health facilities would be on a budget. Most hospitals, clinics and nursing homes would remain privately owned and operated, receiving an annual “global” lump sum budget from the NHP to cover all operating costs. Capital funds would be distributed separately on the basis of health planning goals.
Physicians would be paid based on a simple fee schedule covering all patients or by salary. Physicians in private practice would continue to practice on a fee-for-service basis with fee levels set in negotiations with the NHP. Physicians working in nonprofit hospitals, clinics, capitated group practices, HMO’s, and integrated health systems would be salaried.
Medications would be purchased wholesale. The NHP would negotiate prices with pharmaceutical companies as other countries around the world do today. The NHP would pay pharmacists wholesale costs plus a reasonable dispensing fee for prescription drugs on the NHP formulary.
Investor ownership would be proscribed. Investor ownership of the health care delivery system (hospitals, clinics, etc.) would not be allowed because it raises costs and reduces quality. Regionally dominant health systems and Accountable Care Organizations would be publicly controlled to prevent them from exploiting oligopoly market power.
Financing
The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes that would be fully offset by reductions in premiums and out-of-pocket spending.
Further details of the Physicians’ Proposal are offered in an editorial in the June 2016 American Journal of Public Health, “Moving Forward from the Affordable Care Act to a Single-Payer System” by Drs. Adam Gaffney, Steffie Woolhandler, Marcia Angell, and David Himmelstein.
You can read the editorial at http://ajph.aphapublications.org/doi/10 … 015.303157 The full physicians proposal is online at www.pnhp.org/nhi
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The conservative case for single payer
Efficient. Effective. Practical. Make no mistake, there is a strong conservative case to be made for single payer. This is important because, as our health care crisis deepens, we need to make sure we’re speaking to all Americans. Only then can we can build a broad-based movement that pressures Congress to do the right thing.
Dispel common myths
Myth: Single payer is socialized medicine!
Reality: Medicare-for-all applies the principles of the free market to the delivery of health care. Under traditional Medicare, doctors and hospitals compete to attract patients through service, quality, and access - rather than competing to be in the best-reimbursed insurance plans. Medicare-for-all would open up this patient-centered free market to all Americans.
Myth: Single payer would lead to rationing!
Reality: Today's private health insurance is incredibly restrictive, with narrow provider networks, cost-sharing, and a growing list of treatments that simply aren't covered. Private insurance comapnies have a financial incentive to deny care, and they often do. Medicare-for-all would make it much easier for patients to access medically necessary care.
Myth: Single payer would stifle innovation!
Reality: Americans are justifiably proud of our nation's leadership in medical innovation, but may not realize that most of those innovations are paid for using public funds. As pharmaceutical companies engage in trivial research designed to extend patents, our National Institutes of Health funds truly pioneering work. Medicare-for-all would strengthen the alignment of research with our most pressing health needs.
Expose the Canadian boogeyman
Some of the most pervasive myths about single payer relate to Canada’s Medicare program. Many Americans have heard that Canadians suffer long wait times, and flock to the United States to seek medical care. Thankfully, these myths are easily disproven. Consider the following:
• The 2002 Health Affairs study Phantoms in the Snow found that an exceedingly small number of Canadians seek care in the U.S.
• Waiting lists in Canada can be primarly attributed to lower health spending. Despite this, Canadians do not have to wait to be treated for life-threatening diseases and report fewer unmet health needs overall (see this NBER paper, Table 12).
• Former Canadian Medical Association Journal editor-in-chief and one-time market proponent David Woods says single payer is essential to controlling costs.
• George Mason University law professor Frank Buckley believes Republicans should embrace single payer, and points to the benefits of Medicare in his native Canada.
• Bottom line? Canadian health outcomes are better than American health outcomes, including longer life expectancy and fewer chronic conditions. These gaps have been growing ever since Canada fully implemented its Medicare program in the early 1970s.
Cutting overhead and bureaucracy
Your conservative representative may agree with you that single payer would provide high-quality care, but they may also also argue that the private sector is more efficient than the federal government, and therefore a better steward of our health care dollars.
However, it is our current, market-oriented system that generates the greatest amount of waste and profiteering. Conservatives who hate bureaucracy should be champing at the bit to do away with private insurance company overhead. A February 2017 estimate published in the Annals of Internal Medicine found that single payer would generate $504 billion in administrative savings annually.
Economists and public health experts have consistently shown that single payer is an efficient and effective use of resources. Here are some prominent examples:
• PNHP co-founders, Drs. David Himmelstein and Steffie Woolhandler, argue that single payer would allow for Liberal Benefits, Conservative Spending.
• Nobel laureate Angus Deaton favors single payer “because it will get this [health care] monster that we’ve created out of the economy and allow the rest of capitalism to flourish.”
• Nobel laureate and noted health care economist Kenneth Arrow lauds the Canadian system (with its private practitioners) and says single payer is “better than any other system.”
Boosting American business
Conservative members of Congress often voice concern over the global competitiveness of American business, and rising health care costs are harmful in that regard. Under single payer, U.S. firms might contribute as much to health care as they do now via a payroll tax, but they would no longer need to shop for group policies. They would also be spared the outrageous annual cost increases that have become commonplace in the large- and small-group markets.
For workers, single payer would allow those who are not a good fit for their jobs to seek more productive employment elsewhere instead of staying put in order to preserve health benefits. And would-be entrepreneurs would no longer fear striking out on their own due to a lack of health insurance.
Ultimately, improved Medicare-for-all would ensure a healthier, more financially-secure workforce. Thankfully, employers are starting to take notice:
• The group Business Leaders Transforming Healthcare "strongly supports legislation to transition the United States to a publicly funded health care system."
• MCS Industries founder and owner Richard Master has produced a documentary, FIX IT: Health Care at the Tipping Point, that lays out the business case for single payer.
• Berkshire Hathaway vice-chairman (and longstanding Republican) Charlie Munger says single payer is the solution to America’s health care woes.
• Micro Trap Corporation CEO and former GOP state legislator David Steil urges Congress to pass single-payer reform in order to “truly enhance American competitiveness.”
• Marks Group owner and prominent blogger Gene Marks considers himself a “smaller government, fiscally right-of-center guy,” but has concluded that single payer would be best for business.
Last edited by EdwardHeisler (2017-12-29 11:38:29)
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The current health system is claimed to be a pay in system for which it will be here when you need it but here is the rub in that they are no where to be found later as you have switched company and even gone without as its unaffordable....
The same hold for all of the insurance companies to which the body has been devided up such that now you need to buy dental, vision ect.. just to take care of the whole body when its needed.
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The American health system seems to have developed at a time when most people died by their mid 70s, most fatal diseases were incurable, medical science had only rudimentary understanding of diseases, there was much less mental ill health and there was much more income equality. None of these apply now. I just don't think the system can stand the demands of the modern world. You seem to end up with a system where you persecute maybe 50-60 million of your fellow citizens who probably have genetic weaknesses.
On a similar logic, it's almost as if you had interpreted your "right to bear arms" constitutional right to include SAM missiles, major artillery, fighter jets and atom bombs.
Time moves on...things change. I think the US is failing its people on health.
Last edited by louis (2017-12-28 20:29:18)
Let's Go to Mars...Google on: Fast Track to Mars blogspot.com
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I think the people are failing the people on health. A large part of America's health problems are self-inflicted. Shifting that cost fully onto the government isn't going to make people change their lifestyle.
If America goes with a Medicare-for-all option, they'd better get serious at bargaining with healthcare providers. Develop a price list, and state how much they're willing to pay for each treatment. US government spending on healthcare is already on par with other developed countries that have single-payer, so there is no need to raise taxes. Better yet, put it on a sliding scale based on household income and composition, so as your income goes up, the subsidy decreases, from 100% for those at the bottom (say below the relative poverty line), and 0% for those earning the most (>$100k/year?). Keep the current system of for-profit and non-profit hospitals, they're a lot nicer than the ones we have under a government run system here in the UK...
"I'm gonna die surrounded by the biggest idiots in the galaxy." - If this forum was a Mars Colony
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I'd just like to point out that fatal illnesses are generally incurable, Louis, notwithstanding claims of miracles. Otherwise they wouldn't be fatal.
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About half of the half is only they way that they are due to genetic issues, some are factored in as life changing as the one set of desease is setting in as uncureable and only life tolerateable as either pain of other condition make it chronic. A small percentage are life chioces that are poor but then again underlying are other issues that have not been diagnosed....
Then there are the brain dead people that use alcohol, drugs ect as a way out of the issues to which this seems to be somwhat either genetic in nature and or learned to cope with there own internal protection systems and are about the same as cigarettes for some very distructive.....
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This remains the best plan I have seen that can provide full, high quality and less costly medical care for everyone.
We need to remove the unnecessary "middle man" out of our healthcare system, the insurance industry. They contribute absolutely nothing to improving and expanding our medical healthcare. They are like a cancer and must be removed.
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Louis,
The legislation related to the medical insurance and retirement programs were inflicted upon the American people by the not-so-great-society socialists at a time when there were more young and healthy people paying into the system than there were old and sick people that required income and care. We weren't nearly so in-debted and most of what Americans purchased was still made in America. In short, there was a lot more money to support these sophomoric socialist wealth redistribution schemes that always run out of other peoples' money.
Contrary to your false assertion regarding the matter, the US actually had a mental health care system in the 1970's. There was more "income equality" because there were a lot more poor people. That seems to be what the socialists are always after. They want everyone to be poor and ignorant, because then they're "equal". If they're not all poor and stupid, then they're not equal. If that's not what they want, then the dumbest people on the planet have been the ones trying to implement their schemes. I don't think I want the dumbest people on the planet, or the smartest evil people on the planet, deciding which doctor I can go to.
Were there no Americans with "genetic weaknesses", as you put it, before our health insurance programs were established?
Is it possible that nobody had any definitive evidence of "genetic weaknesses" in the 1970's?
Is it possible that people who weigh two or three times what a person of their height normally weighs aren't living very healthy lifestyles?
Here's a thought. The lawyers decided that they needed to figure out how to make money off of the suffering of other people, so they lobbied the people who make laws to give them more money for, you know, "working". The US non-educational system creates far more lawyers today than it does doctors. They all have to figure out how to make money and the best way to do that is to create contrived systems for their own benefit.
EdwardHeisler,
There is no conservative case for a single payer health care system because socialism is definitely NOT a conservative principle. In that respect, my conservative representatives have pretty much the same opinion regarding this spectacularly stupid idea as I do. Wave the magic socialism wand and all real world problems suddenly disappear. Obamacare was going to fix the problems with our health insurance system, which is why our health care now costs three times what it did previously for the same or reduced benefits. That's the socialist model. Create a problem that didn't exist previously, complain that it hurts, and then propose giving more money to the people who made the problem worse than it was to begin with.
All government systems and agencies are inefficient, ineffective, and impractical. There is nothing our government does particularly well, to include national defense. If it did national defense well, a small group of camel herders wouldn't be capable of hijacking four airliners and flying them into skyscrapers.
Fact: Single payer is the dictionary definition of socialized medicine. If you can't get the care you need, then you're SOL unless you have enough money after the government takes even more money from your paycheck to travel abroad to obtain better treatment. There is no free market principle that says you collect money from other people at the point of a gun to give to other people. That's the free theft principle of socialism and communism.
Fact: Single payer does lead to rationing in all actual implementations here on planet Earth. There is no way to lower cost without giving up something. That's a principle that people who passed Economics 101 in college would understand. If I wanted to give up some part of our health care system to lead to better outcomes, it would be the lawyers and legislators (mostly just more lawyers).
That non-rationing rationing system and socialist government control is why they let that kid die in the UK instead of allowing our own doctors to come to him, free of cost to their government and the patient's parents, with the only experimental treatment that could have reversed his condition. Their court system wasted that kid's life screwing with his parents until their child died, just to prove to everyone that the government has absolute "control" over life and death and so it would not be demonstrated that the NHS is the ineffectual socialist garbage that it truly is. Canadians DO have to wait to be treated for life-threatening diseases, unless you can explain why the other patients of my wife's brain surgeon from UTMB came from Canada, UK, other European countries, and the Middle East to see him.
Fact: Single payer does stifle innovation. An early death waiting for treatment that's not coming is not a healthcare innovation.
Canadians and Europeans live longer lives because they don't eat themselves to death or constantly get drunk and stoned out of their minds. That's a personal problem that a new socialist health care system won't solve, unless you intend to ration care, which is something you said a single payer system would not do, by not treating fat, drunk, or stoned people. Plainly visible effects are the "boogeyman" for all socialists. We somehow manage to keep our citizens alive for nearly the same length of time, even with all the health problems they caused themselves through their own behavior and all the problems government intervention in things they know nothing about causes.
The lawyers are a cancer on our health care system and need to be removed. The "middle man" is the one who underwrites the hospital stays, brain surgeries, cancer treatments, etc. If the costs come down, then we can continue using the system we have. If not, then we can try your socialist nonsense and watch that fail, too. Maybe the genius of the NHS is that they let everyone's teeth rot as they age so it's too painful to eat enough food to get fat. I think they're onto something there.
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kbd512. In view of your uncritical support to right-wing bigots, enemies of the American people and uncritical support of counterfeit patriots like Trumpy you lack any credibility on this board.
I have to ask you this serious question. Are you a functioning as a troll and apologist for Trumpy and his Wall Street and corporate pals on this discussion board or are you simply a wannabe lapdog for that lying a-hole? Perhaps you just fancy yourself as a "stable "genius" like your low life role model Trump.
You're stock talking points have grown old. You might try writing something original. Or you have already tried that and failed.
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EdwardHeisler and kbd5412 stop the naming labels of conservative, socialist ect... as these do not matter nor will finger pointing.
I said that insurance was a pay in system from long ago or a pay here to get service concept.
During the 1920s, individual hospitals began offering services to individuals on a pre-paid basis, eventually leading to the development of Blue Cross organizations in the 1930s.
history of health insurance in the united states - American College
The single payer concept is a flat fee program that gets you covered at what I would call tiered approach to care. It takes away the loan sharking that currently is corporate business gambling on policy issurance. It would remove the uninsured, remove the up or down price gouging at the doctors office, hospitals and pharmaceutical industry from pricing drugs to off the charts cost. This would force cost constraints to what is charged for a service as it relates to health care.
There is nothing that would say that an insurance company still could not do a good business.
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Medicaid, medicare under state or federal guidelines.
Medicare and Medicaid are both government programs that help pay for health care. However, the benefits, costs, and eligibility requirements are different. Who is eligible for Medicaid? You may qualify for free or low-cost care through Medicaid based on income and family size. In all states, Medicaid provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. This sort of sounds simular to Obamacare with intent... programs are determined by age and income ect...
https://www.medicare.gov/your-medicare- … icaid.html
https://www.medicaid.gov/medicaid/eligi … index.html
State by state requirements for medicaid, medicare
https://www.healthcare.gov/blog/who-qua … -medicaid/
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EdwardHeisler,
Until you respond with something other than a personal attack, appeal to authority, or outright lie, I'll keep pointing out the obvious problems, logical fallacies, and outright lies to people who are not blinded by their fixation with their political ideology. If anything you've proposed here actually provided better health care, then the rich would be running for the exits any time they had a serious health care problem.
I think your uncontrollable obsession with President Trump is unhealthy and you should probably go talk to a psychiatrist. If one man you've never met makes you so upset that you feel the need to mention him in every response to other people you disagree with, then I think you're suffering from a mental issue. For your own sake, please seek professional help.
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Why do you support a President who is guilty of treason and who hates a free press, the Bill of Rights and anyone who is not white?
From your behavior in support of Trump and his fellow bigots, one has to conclude that you are also a racist and counterfeit patriot.
If you hate our democratic rights and freedoms so much feel free to leave this nation. Perhaps you'll be happier in Russia or North Korea.
Will you be leaving anytime soon? I'll help you pack your tent!
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SpaceNut,
Why is it that EdwardHeisler has posted here singing SpaceX's praises and condemning NASA, yet he somehow thinks that if only our government had complete control over their health care, that costs would magically drop and everything else would somehow work better than it does?
Who here really wants a DMV or Post Office experience when they need medical care?
Think that won't be exactly how it works?
If so, then visit a VA hospital.
After the last government power grab for more control over our health care, our health care costs didn't go down, stay the same, or slightly increase as the bugs in the system were worked out. Our insurance costs tripled and they've gone up from there every single year. We now pay three times as much as we did for the same health care.
I want to know where we can find this paragon of efficiency in government-run institutions, because it sure as hell isn't here.
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Why do you support a President who is guilty of treason and who hates a free press, the Bill of Rights and anyone who is not white?
From your behavior in support of Trump and his fellow bigots, one has to conclude that you are also a racist and counterfeit patriot.
If you hate our democratic rights and freedoms so much feel free to leave this nation. Perhaps you'll be happier in Russia or North Korea.
Will you be leaving anytime soon? I'll help you pack your tent!
EdwardHeisler,
Go see a psychiatrist. Seriously. You need help.
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It's clear that your billionaire hero, role model and traitor, Trump, is the one who needs to see a shrink. Along with his "know-nothing" cultists such as yourself.
Leave this discussion board. We are not bigots. The Mars Society does not support racism and bigotry. There are several white supremacist boards you'll be far more comfortable posting on. I don't think anyone else from here will be joining you on your journey to these boards.
Last edited by EdwardHeisler (2018-07-16 15:35:54)
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I do realize that the topic is within the free chat area but none of this is truely about the topic being discussed.
Medicaid and medicare are already in existence and should be leveraged to make better health care for all through a guildline of cost and conditions fore each person to make use of.
I do realize that the VA which is the authorized service provider to veterans is broken but that is not the issurer now is it its the service provider.
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EdwardHeisler,
I've reported your last post to the mods to remove the links to the racist websites that you posted here. If you don't support racism and bigotry, then maybe you can remove those links yourself. I'm not leaving this discussion board because you can't separate your own opinions of other people you've never met from objective reality. Calling other people names that you have political disagreements with is not a form of argumentation accepted by adults.
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I did post a couple times my suggestion that America adopt Canada's healthcare system. It's a lot less comprehensive than proposed in the initial post. It would be left up to states to decide how it's paid for. I gave Ontario's premium converted to US dollars. It would replace Medicare and Medicaid, for middle income earners the premium would be the same as Medicare premium it replaces. Veterans would be covered too; VA coverage is more comprehensive but this would reduce VA costs.
::Edit:: Canadian healthcare
Last edited by RobertDyck (2018-07-16 20:34:19)
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Quick Pay Portal is a wonderful method to determine any of your issues in regards to the hospital expenses. The patients are not to stress over saving the installment for their drugs any more. A helpful way has been propelled by a presumed social insurance organization to encourage its kin in giving them no less than 10 times snappier administrations for installment of their bills.
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The issues for care is not knowing when you go to get help is how much its going to cost and that if you could see a price index for all locations that you might go to would put the breaks on the runaway gouging that they are all doing...
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