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
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.
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
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.
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
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
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.