PNHP Research: The Case for a National Health Program

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Over the past two decades, PNHP research has “framed” the debate and focused it on the need for fundamental health care reform. Some of these findings have become so well known that new members of PNHP (and most members of Congress) may not know that we are the source:

• Administrative costs consume 31 percent of US health spending, most of it unnecessary.
  _{(Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003)}
  
  

• Medical bills contribute to half of all personal bankruptcies. Three-fourths of those bankrupted had health insurance at the time they got sick or injured.
  _{(“Illness and Injury as Contributors to Bankruptcy,” Himmelstein et al, Health Affairs Web Exclusive, February 2, 2005.)}
  
  

• Taxes already pay for more than 60 percent of US health spending
  
  Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it.
  _{(Woolhandler, et al. “Paying for National Health Insurance — And Not Getting It,” Health Affairs 21(4); July / Aug. 2002)}
  
  

• Despite spending far less per capita for health care, Canadians are healthier and have better measures of access to health care than Americans.
  _{(Lasser et al. “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey,” American Journal of Public Health; July 2006, Vol 96, No. 7)}
  
  

• Business pays less than 20 percent of our nation’s health bill. It is a misnomer that our health system is “privately financed” (60 percent is paid by taxes and the remaining 20 percent is out-of-pocket payments).
  _{(Carrasquillo et al. “A Reappraisal of Private Employers’ Role in Providing Health Insurance,” NEJM 340:109-114; January 14, 1999)}
  
  

• For-profit, investor-owned hospitals (link 1¹, 2², 3³, & 4⁴), HMOs⁵ and nursing homes⁶ have higher costs and score lower on most measures of quality than their non-profit counterparts.
  <sub>1. Editorial by David Himmelstein, MD and Steffie Woolhandler, MD in the Canadian Medical Association Journal
  2. Devereaux, PJ “Payments at For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J., Jun 2004; 170
  3. Devereaux, PJ “Mortality Rates of For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J, May 2002; 166
  4. Himmelstein, et al “Costs of Care and Admin. At For-Profit and Other Hospitals in the U.S.” NEJM 336, 1997
  5. Himmelstein, et al “Quality of Care at Investor-Owned vs. Not-for-Profit HMOs” JAMA 282(2); July 14, 1999
  6. Harrington et al, “Himmelstein, et al “Quality of Care at Investor-Owned vs. Not-for-Profit HMOs” JAMA 282(2); July 14, 1999,” American Journal of Public Health; Vol 91, No. 9, September 2001</sub>
  
  

• Immigrants¹ and emergency department visits² by the uninsured are not the cause of high and rising health care costs.
  <sub>1. Mohanty et al. “Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis,” American Journal of Public Health; Vol 95, No. 8, August 2005
  2. Tyrance et al. “US Emergency Department Costs: No Emergency,” American Journal of Public Health; Vol 86, No. 11, November 1996</sub>
  
  

• The uninsured do not receive all the medical care they need — one-third of uninsured adults have chronic illness and don’t receive needed care¹. Those most in need of preventive services are least likely to receive them.
  _{1. Wilper, et al “A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults” Ann Intern Med, Aug 2008; 149: 170 - 176.}
  
  

• The US could save enough on administrative costs¹ (more than $350 billion annually) with a single-payer system² to cover all of the uninsured.
  <sub>1. Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003
  2. “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance,” JAMA 290(6): Aug 30, 2003</sub>

• Competition among investor-owned, for-profit entities has raised costs, reduced quality in the US

_{(Himmelstein and Woolhandler; BMJ 2007;335:1126-1129 (1 December), doi:10.1136/bmj.39400.549502.94)}

• The Canadian single payer healthcare system produces better health outcomes (Cite 1, Cite 2) with substantially lower administrative costs (Cite 3, Cite 4) than the United States.

1. Guyatt GH, et al. “A systematic review of studies comparing health outcomes in Canada and the United States.” Open Medicine (2007); 1(1): E27-35.

2. Lasser KE, Himmelstein DU, Woolhandler S. “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” American Journal of Public Health (July 2006); 96(7): 1300-1307.

3. Himmelstein DU, Lewontin JP, Woolhandler S. “Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada.” American Journal of Public Health. (1 Feb. 2006); 86(2):172-178.

4. Woolhandler S, Campbell T, Himmelstein DU. “Cost of Health Care Administration in the United States and Canada.” New England Journal of Medicine. (21 August 2003); 349(8).

• Computerized medical records¹ and chronic disease management² do not save money. The only way to slash administrative overhead³ and improve quality (Cite 4, Cite 5) is with a single payer payer system.

1. Woolhandler, et al. “Hope And Hype: Predicting The Impact Of Electronic Medical Records,” Health Affairs, September/October 2005; 24(5): 1121-1123.

2. Geyman, J “Disease Management: Panacea, Another False Hope, or Something in Between?,” Ann Fam Med 2007;5:257-260. DOI: 10.1370/afm.649.

3. Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003

4. Schiff, et al “A Better Quality Alternative” JAMA, 272(10); Sept. 12 1994

5. Schiff, et al “You Can’t Leap a Chasm in Two Jumps,” Public Health Reports 116, Sept / Oct 2001

• Alternative proposals for “universal coverage” do not work. State health reforms over the past two decades have failed to reduce the number of uninsured¹.
  _{1. Woolhandler, et al “State Health Reform Flatlines,” International Journal of Health Services, Volume 38, Number 3, Pages 585-592, 2008}