Hot Topics

SIngle-payer National Health Insurance 


Testimony in support of single-payer national health insurance

By Steffie Woolhandler M.D., M.P.H., M.A. (Hon., Harvard)
FACP Prof. of Public Health, City University of New York at Hunter College
Albert Einstein College of Medicine

Democratic Platform Drafting Committee Hearing, June 17, 2016 

I am a primary care doctor and professor of medicine and health policy. In 1986, I co-founded the non-partisan organization Physicians for a National Health Program, whose 20,000 members advocate for single payer reform.

Our proposals for single payer reform have appeared in the New England Journal of Medicine, The Journal of the American Medical Association, and most recently in the American Journal of Public Health. That proposal and references for my statements appear in my written testimony.

1. The ACA has not solved the health care crisis. About 30 million Americans are uninsured today. And 25 million would remain uninsured even if all states were to accept the Medicaid expansion.

2. Millions more have such hollowed-out coverage that they can’t afford care. Deductibles on employer-sponsored plans increased 255% between 2006 and 2015. Deductibles in the ACA’s exchange Silver plans average $3,064.

My research with Elizabeth Warren, when we were both professors at Harvard, found that medical problems were a cause of 62% of all personal bankruptcies. The majority of the medically bankrupt had private insurance that failed to protect them. This year, the Consumer Financial Protection Bureau reported that unpaid medical bills are by far the most common debts sent to collection agencies.

3. Many Americans have been forced into insurance that limits their choice of doctors and hospitals, often excluding leading cancer centers and teaching hospitals. Medicare for All would assure everyone a free choice of doctor and hospital. 

4. Health inequality is on the rise. Today, the wealthiest American men live, on average, 15 years longer than the poorest. Meanwhile, the life expectancy gap has fallen in Canada. Overall, Canadians and Europeans now live 2 to 3 years longer than Americans.

5. Single payer systems in these nations provide first dollar coverage, while spending about half as much per person as we do.

6. The economic numbers on single payer add up. At the outset, government health spending would rise, but would be fully offset by reductions in premiums and out-of-pocket costs. Over the longer term, single payer reform would be less inflationary than our current market-based system. (Markets are designed to expand, and they do, especially when they're heavily subsidized.)

Single payer would save about $3.3 trillion on insurance overhead over the next decade by replacing private health insurers, whose overhead averages 12%, with a single public insurer with overhead of 2-3%, as in the traditional Medicare program or Canada’s single payer.

Single payer reform would also slash the paperwork that insurers inflict on doctors and hospitals, saving another $2.75 trillion over 10 years. Doctors would send all bills to one place using a simple billing form, and hospitals would stop sending bills. Instead, they’d be paid negotiated lump-sum budgets – much as we pay fire departments. Administration consumes 25% of hospital budgets in the U.S., vs. 12%, in Canada and Scotland.

Overall, a single payer reform would save more than $6 trillion on paperwork over the next decade, enough money to cover all of the uninsured, and to upgrade coverage for those of us with insurance.

7. A single payer reform could save an additional $2 trillion over ten years by using its leverage as a monopsony buyer to drive down drug prices.  This strategy has allowed Europeans and Canadians (as well as the VA) to get drugs at half–price. 
8. A Medicare buy-in or public option will not work. It would improve choices for some Americans but fail to garner most of the administrative or drug savings available through single payer. Moreover, as in the Medicare Advantage program, overall costs would go up because private insurers would cherry pick the healthiest patients, shunting expensive and unprofitable patients to the public option. We have already seen this dynamic at work in the collapse of the non-profit insurance coops under the ACA. In insurance competition, good guys finish last.

9. Single payer is popular. Most doctors, like other Americans, now favor national health insurance, and according a recent Gallup survey, the public now greatly prefers it to Obamacare.

10. In summary, single payer reform is the only route to affordable and sustainable universal coverage. (We) can not pretend that minor tweaks to our failing health care system will fix it.



A horror movie could be made of a person awakening to find their body transformed to the opposite sex. As a physician, I understand our gender is most strongly held in our brain. There are people who have the misfortune to have a birth defect in that part of their brain resulting in switching their gender identity from that of their external genitalia. When children have birth defects such as a cleft lip or club foot we don’t think it odd to have those surgically repaired, to become normal. But, a transgendered child or adult is erroneously considered by many to have made a “choice”. People who would never dream of laughing at a person with a scarred face, a missing leg or other severe defect see a transgender person as fair target for social ostracism (or worse). There is no connection between gender dysphoria and pedophila or abuse of children. Many trans-people live among us, working, shopping, attending school; without attracting notice. Most transgendered individuals want nothing more than acceptance and to be allowed to live their lives in peace, as the gender fitting their brain. Those who don’t suffer from this biologic solecism should be grateful and gracious.




Zika is not Ebola. It is worse for us. Ebola was mostly far away, Zika is coming. It is certain. The number of US cases increases every week, carried by infected people. When Mosquito season hits this season- thousands of Americans will become infected by mosquito bites, especially in the Southern states. There is no cure, there is no vaccine. The virus does not kill in the way Ebola kills. Zika causes severe birth defects. It kills the hopes and dreams of mothers and fathers by causing untreatable microcephaly (very small brain).


In February, President Obama asked Congress to approve emergency funds to help control the mosquitoes that spread the virus and support vaccine research. The funding is opposed by members of Congress from our State. By July and into the next year, we will see the terrible results of this inaction. As a physician, I ask you to urge our members of Congress to act now to approve the Zika funding. It is time to put the lives of patients and unborn children over politics to provide this important emergency money to help control the spread of Zika.