A Health Care System That You Might Actually Like Isn't as Far off as It Seems

More than 2,000 doctors across the United States have endorsed a detailed proposal for transforming America’s broken for-profit health care system into a publicly funded, universal model that would knock down all barriers to treatment.


Just published in the American Journal of Public Health by a 39-member Working Group on Single-Payer Program Design, and signed by a growing number of physicians and medical students, the proposal takes a hard look at just how effectively the Affordable Care Act has delivered on President Barack Obama’s declaration last year that “health care is not a privilege for a few, but a right for all.”

“The U.S continues to spend strikingly more on health care than other industrialized nations, while our health outcomes lag behind,” the doctors conclude. “Even with the ACA fully implemented, an estimated twenty-seven million will remain uninsured, while many more face rising copayments and deductibles that compromise access to care and leave them vulnerable to ruinous medical bills.”

In fact, a poll jointly released earlier this year by the Kaiser Family Foundation and the New York Times found that one in five insured people in the United States reports having difficulty paying medical bills.

In light of these failures, the doctors argue that we face a “historic crossroads” in the American health care system: “One way would take us further down the path laid out by the ACA: down this road, millions of Americans remain uninsured, underinsurance grows, costs rise, and inefficiency and the search for profits are abetted. An alternative, market-based route, favored by conservative political leaders but not, according to surveys, by the public, would roll back the ACA’s expansion of coverage, degrade Medicare and Medicaid, and reward entrepreneurs at the expense of patients.”

Instead, the doctors offer a “third path”: a single-payer National Health Program (NHP) that would be funded almost entirely by already-existing government health funds, in addition to some new taxes that the doctors say would be “offset by savings in premiums and out-of-pocket costs.” Their plan has been updated from a 2003 proposal to speak to the nuances of the modern medical system under the ACA.

According to the proposal, all resident of the United States—including undocumented people—would receive an NHP card “entitling them to care at any hospital or doctor’s office,” explains a fact sheet on the proposal released by the advocacy organization Physicians for a National Health Program. “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.”

The doctors estimate that this plan would save more than $400 billion a year by doing away with the massive overhead of private insurers, as well as the mountains of paperwork that hospitals and doctors are currently required to complete. The elimination of this waste would free up the funds to provide full coverage of prescription drugs, dental and long-term care.

The doctors’ recommendations come in the midst of a renewed debate over health care, as presidential hopeful Bernie Sanders calls for a single-payer, universal system and rival Hillary Clinton repeatedly criticizes this plan from the right while calling for the preservation of the ACA.

“Nobody is talking about getting rid of the ACA without, at the same time, putting something in its place—single payer,” Dr. Adam Gaffney, a pulmonary disease and critical care specialist who co-chairs of the working group that drafted the proposal, told AlterNet. “I would say that there is no clear way to build on the ACA through universal health care. There were 29 million people uninsured last year, 39 million under-insured. There’s a lot of inefficiency in our health care system.”

“The discourse around health care has changed, and that is powerful,” Gaffney continued. “People are talking about single payer in ways they weren’t before. The ACA is fully implemented and what we have is what we’re going to get. The problems we’re talking about—with the un-insured and under-insured—are not going away. Whoever is elected in 2016 will have to face these problems.”

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