Single-payer national health insurance is a system in which one entity (usually a government agency) organizes the financing of health care, leaving the delivery of care mostly in private hands.
All residents would be automatically enrolled in the program at birth and be covered for life. Everyone would have equal access to comprehensive, high-quality health care, with no premiums, co-pays or deductibles.
Financed by a system of progressive taxation, the program would pay for all necessary medical expenses, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug, and medical supply costs. Patients would have free choice of doctor and hospital. People would no longer be afraid of unaffordable medical bills and would never be bankrupted by medical expenses.
In some single-payer systems, such as in Canada, hospitals receive lump-sum government payments rather than depend on piecemeal billing and negotiations with insurance companies. Had we such a system, it’s likely we would have prevented the closing of St. Vincent’s Hospital and many other hospitals around New York City.
There is a bill in Congress, the Expanded and Improved Medicare for All Act, H.R.676, that would establish such a program. Polls show that its principles have solid majority support, including among physicians and nurses. The bill has been endorsed by many unions, civic, and faith based organizations.
Why do we need it?
We already spend twice as much as other industrialized countries on health care but we receive mediocre results. Some Americans benefit from very good health care but millions do not. Fifty-four percent of Americans report delaying needed care in 2010, while 25 percent report having trouble paying medical bills. Many must choose between paying for medicine and paying for food or rent.
Approximately 45,000 deaths each year in the U.S. are associated with a lack of health insurance. Sixty-two percent of personal bankruptcies are a result of illness and medical bills.
We spend 17.7 percent of our GDP on health care and this is a terrible drain on our economy. Our reliance on private, for profit health insurance companies wastes billions of dollars every year on administrative costs. This money could be going towards providing health care if we eliminated this expensive middleman who adds cost but no value to the system.
How do we know it would work?
We already have a single-payer-like system in this country and it has been working well for nearly 50 years: Medicare. We also have publicly financed nonprofit health care for the military, veterans, and the poor. They all could be improved but they work and pay half of our country’s health care bill.
A single-payer system would bring health care justice to our country. It would be transparent, publicly accountable, fair, and efficient. It is time to end the immorality of our unequal, chaotic, inefficient health care “non-system” and join the rest of the industrialized world in providing equal access to high-quality health care for all our people.
Dr. Alec Pruchnicki practices internal and geriatric medicine and serves on the board of the N.Y. Metro chapter of Physicians for a National Health Program (pnhpnymetro.org). He resides in the West Village.