Examining the Single Payer Health Care Option

Health, Employment, Labor, and Pensions Subcommittee Hearing
U.S. House of Representatives
June 10, 2009

Marcia Angell, M.D.:

I want to mention one final and very important reason for enacting a nonprofit single-payer health program. We live in a country that tolerates enormous and growing disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status.

One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities. We need to acknowledge the same thing for health care. Providing these essential services to all Americans, regardless of who they are, marks a decent and cohesive society. It says that when it comes to vital needs, we are one nation, not 300 million individuals competing with one another.


Walter Tsou, M.D., M.P.H.:

President Obama has stated that if he were to start over again he would favor a single-payer system, but argues that moving to single-payer is too radical.

Well, I come from Philadelphia where revolutionary ideas are celebrated not dismissed. Our most famous radical document begins with the words, “We the People”. Not “We the Insurers”. “We the People of the United States, in order to form a more perfect union . . . to promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity do ordain and establish this Constitution for the United States of America.” This nation captured the world’s imagination with bold ideas that put the people first. It is time for our own generation’s revolution.


David Gratzer, M.D.:

Critics of the American system note that it fails to provide universal coverage to its citizens. But Canada’s single-payer system also denies care; instead of denying insurance coverage, Canada’s public insurance plans simply limit the supply of costly medications and capital-intensive procedures.

These challenges appear in different forms across the single-payer world. Wait times, rationed care and inefficient public management is inevitable in single-payer systems because they all face the same health-care demands as the American system.


During the questioning by committee members:

Rep. Dennis Kucinich: Dr. Gratzer, you’ve tried to make the case for rationing in Canada – worse than it is in the U.S. Do you know what Statistics Canada – the analogue to the U.S. Census – says the median wait time is across Canada for elective surgery?

Dr. David Gratzer: Why don’t you inform us,sir?

Kucinich: It’s four weeks. And what does Statistics Canada say the median wait time for diagnostic imaging like MRIs is?

Gratzer: I could tell you the Ontario government recently looked at that for…

Kucinich: It’s three weeks.

Gratzer: … for cancers, was six months.

Kucinich: It’s three weeks. How many uninsured are there in Canada?

Gratzer: Probably relatively few.

Kucinich: That’s right, none or very few. How many medical bankruptcies are there in Canada?

Gratzer: Depends on how you define medical bank..

Kucinich: None or very few. How many insured Americans go without needed care due to high cost of health care which is due to health insurance companies?

Gratzer: (Pause) Am I allowed to answer, or are we just going to continue to…

Kucinich: If you have an answer, you can answer. But if you don’t, I’ll answer. What’s your answer?

Gratzer: Go for it, sir.

Kucinich: What’s your answer?

Gratzer: Why don’t you answer your question, sir?

Kucinich: What’s your answer?

Gratzer: My answer…

Kucinich: How many insured Americans go without needed care due to the high cost of health care which is due to health insurance companies?

Gratzer: (Silence)

Kucinich: The witness isn’t responding.

Gratzer: The witness is delighted to speak further on those statistics and other statistics, but you keep cutting me off, sir.

Kucinich: You respond, if you have an answer. You didn’t give an answer to the other one.

Gratzer: I don’t want to be led down a garden path. If you’d like to ask me a question, I’d be…

Kucinich: You’ve shown a garden here to members of this committee and to the audience. There’s another side to this picture you don’t seem to be aware of even though you want to be an expert on Canada. Can you provide us with an answer on this one about America?

Gratzer: My position is respectable, and I dislike your comment, sir.

Kucinich: Do you have an answer? How many insured Americans, insured, go without needed care due to high costs of health care due to health insurance companies?

Gratzer: (Silence)

Kucinich: He has no answer. Well what the answer is is that it’s one out of every four. So we’re trying to make a case here that somehow Canada is in a mess, but we’re not focusing on the fact that in the United States there are people who aren’t getting needed care, and this gentleman has expected us to believe that rationing is worse in Canada. I don’t know how we can buy that. Now if single payer is so bad, maybe the gentleman – the doctor – can explain to us why sixty percent of U.S. doctors want it according to the peer-reviewed Annals of Internal Medicine, April, 2008.

(off camera voice): Are you going to let him answer this one?

Kucinich: He can answer it, if he can answer it.

Gratzer: I would suggest that many physicians in the United States are unsatisfied with their system, and rightly so. I would suggest that many physicians are looking for reform, and rightly so. But I would suggest that many physicians are unaware of what really goes on single payer systems, perhaps illustrated well by some of the comments that you’ve already made…


Although there are many individual heroes in the single payer movement, joint citizen activism has played a crucial role in bringing the single payer message to a formal, official hearing before a committee of the House of Representatives – a hearing devoted exclusively to single payer.

Tomorrow, Sen. Kennedy’s Health, Education, Labor, and Pensions committee will hold a hearing on “Healthcare Reform.” At the top of the list of the twenty-four witnesses is one of our heroes, PNHP’s Margaret Flowers, M.D., who previously had asked Sen. Baucus to bring single payer to the table, shortly before her arrest.

There are many effective channels for citizen activism. In whatever form you choose, let’s have a whole lot more of it please.