Clare Fauke

FOR IMMEDIATE RELEASE, June 10, 2020

Contact: Clare Fauke, communications specialist, Physicians for a National Health Program, clare@pnhp.org, 312-782-6006
Dr. Adam Gaffney, Physicians for a National Health Program, agaffney@cha.harvard.edu

Even before soaring unemployment caused millions of Americans to lose their health insurance, 18.2 million individuals at increased risk of severe COVID-19 were either uninsured or underinsured, according to a new study published today in the Journal of General Internal Medicine by researchers at Harvard Medical School and CUNY’s Hunter College. Although most of those at high medical and financial risk were white, racial minorities were overrepresented.

Researchers determined who was at risk of severe COVID-19 based on age and medical risk factors such as diabetes. They found that Blacks, Native Americans, lower-income individuals of all races/ethnicities, and those residing in rural areas or in states that had not expanded Medicaid were doubly disadvantaged: they were both more likely to be at high risk of severe COVID-19 and to lack adequate coverage. For instance, compared to non-Hispanic whites, Blacks were 42% and Native Americans 90% more likely to be at risk for severe COVID-19, and high-risk persons from those racial groups were 51% and 53% more likely to have inadequate coverage compared to high-risk whites. Persons in states that failed to expand Medicaid were 6% more likely to be high risk, and 52% more likely to have inadequate coverage compared to those in states that accepted the ACA’s Medicaid expansion. Hispanics at high medical risk were more than twice as likely as non-Hispanic whites to have inadequate coverage.

“The pandemic is laying bare the lethal inequality of American society and American health care,” said lead author Dr. Adam Gaffney, a pulmonary and critical care physician at the Cambridge Health Alliance and Harvard Medical School. “Our ICU has been flooded with poor and minority patients; having COVID-19 is scary enough without worrying that you’ll be bankrupted by medical bills,” he added.

Despite recent federal actions to help fund COVID-19 care, and some insurers’ promises to upgrade coverage for the disease, many American still lack protection from COVID-19’s costs.  The Families First Coronavirus Response Act mandated full coverage for COVID-19 testing, but not for treatment, and the CARES Act provided some funding for hospitals treating uninsured patients, but the protection is far from adequate. While some private insurers have promised to waive copays and deductibles for treatment as well as testing, this promise doesn’t apply to out-of-network care, or to the majority of privately-insured workers whose employers are self-insured. Moreover, most of these waivers will expire by July 1. A Gallup poll found that many remain fearful of treatment costs, with 14% of Americans saying they would avoid care because of costs even if they develop symptoms of COVID-19.   

“These promises of new protections for patients with COVID-19 are full of holes,” noted senior author Dr. Danny McCormick, a primary care physician and associate professor at Harvard Medical School. “COVID-19 threatens the health of people everywhere, but only in the U.S. will it also ruin patients financially. When people avoid testing and care because they fear the costs, it fuels the epidemic’s spread,” he added. 

The investigators also noted that the new federal legislation and insurers’ promises won’t help patients with COVID-19-like symptoms who are found to have a different diagnosis. “It’s not just COVID care that’s unaffordable,” said co-author Dr. Steffie Woolhandler, Distinguished Professor of Public Health at CUNY’s Hunter College and a Lecturer in Medicine at Harvard Medical School. “Patients with heart disease, asthma, and diabetes need protection too. Medicare for All is the long-term answer. But in the meantime, passage of the stopgap Medicare expansion bills introduced by Sen. Bernie Sanders and Rep. Pramila Jayapal would ensure that patients can get the care they need during the crisis, regardless of their diagnosis.”

“18.2 Million Individuals at Increased Risk of Severe COVID-19 Illness Are Un- or Underinsured,” Adam W. Gaffney, M.D., M.P.H., Laura Hawks, M.D., David H. Bor, M.D., Steffie Woolhandler, M.D., M.P.H., David U. Himmelstein, M.D., Danny McCormick, M.D., Journal of General Internal Medicine, published online ahead of print June 10, 2020. DOI: 10.1007/s11606-020-05899-8

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 23,000 members support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.

FOR IMMEDIATE RELEASE: April 28, 2020
Contact: David Himmelstein, M.D., dhimmels@hunter.cuny.edu
Steffie Woolhandler, M.D., M.P.H., steffie_woolhandler@hms.harvard.edu

More than a quarter (26.6%) of America’s nearly 14 million patient-contact health personnel are at risk of severe illness or death from COVID-19 because of age or chronic conditions, a new study found. Researchers also reported high rates of uninsurance and poverty among frontline health workers, who are likely to be exposed to COVID-19 at work. 

According to a study published today in the Annals of Internal Medicine, millions of Americans whose health care jobs bring them into direct contact with patients have medical conditions like diabetes or heart disease that put them at high risk of death if they contract COVID-19. The study also found that 28.6% of all patient-contact personnel lack paid sick leave, including 1.12 million of those with underlying health problems. About 275,000 health care workers with high-risk conditions are also uninsured, including 11.4% of those with diabetes, and 20.8% of those with chronic lung disease. 

The study, conducted by researchers at the City University of New York (CUNY) at Hunter College and Harvard Medical School, analyzed data from two national surveys of thousands of health workers. The researchers identified personnel who work directly with patients, such as doctors, nurses, and nursing aides, and then determined how many of them were over 65 or had an underlying medical condition that puts them at high risk of severe illness and death from COVID-19, including heart disease, chronic lung disease, diabetes, severe obesity, moderate or severe asthma, and liver disease. The authors also analyzed Census data to determine health insurance coverage and incomes of workers in hospitals, home care agencies, and nursing homes.

The study found that among nursing home workers — a group at particularly high risk of COVID-19 infection — 11.5% are uninsured, compared to the national insurance rate of 9.1%. Home care workers, few of whom have access to personal protective equipment, have an even higher uninsurance rate of 14.9%. Researchers also found that more than 600,000 medical personnel have family incomes below the federal poverty line, which likely impairs their ability to maintain social distancing outside of work.

“Health care workers are being celebrated as heroes, but they’re denied the health coverage, sick leave benefits, and incomes they need to protect themselves and their families,” commented Dr. David U. Himmelstein, the study’s lead author who is a distinguished professor at CUNY’s Hunter College and a lecturer at Harvard Medical School. “The pandemic has illuminated how warped our economy and values have become. Financiers working in plush offices or luxury homes make billions shorting stocks. Meanwhile, many Americans doing the most essential and dangerous work, including health personnel, grocery workers, bus drivers, or delivery drivers, can’t make ends meet or afford medical care.”

Study co-author Dr. Steffie Woolhandler, an internist, distinguished professor at Hunter College, and co-founder of Physicians for a National Health Program, added, “While essential workers put themselves in harm’s way, Congress and the President are leaving many of them unprotected and impoverished. They’ve passed paltry measures to expand coverage for coronavirus testing and to shore up hospitals’ finances, but more than half a million health workers — and more than 30 million other Americans — remain uninsured. Our health insurance system is broken, and only Medicare for All can fix it.”    

“Health Insurance Status and Risk Factors for Poor Outcomes with COVID-19 Among U.S. Health Care Workers: A Cross-Sectional Study.” David U. Himmelstein, M.D., Steffie Woolhandler, M.D., M.P.H. Annals of Internal Medicine, April 28, 2020

Physicians for a National Health Program (PNHP) is a nonprofit organization whose 23,000 members advocate for single-payer Medicare-for All; PNHP played no role in funding or conducting this analysis.

FOR IMMEDIATE RELEASE: April 28, 2020
Contact: Steffie Woolhandler, M.D., M.P.H., swoolhan@hunter.cuny.edu

In prisons and jails around the country, COVID-19 infections and deaths are occurring at lightning speed among both inmates and the staff who enter and leave the prison each day. In a commentary published today in JAMA Internal Medicine, physicians from Harvard Medical School and City University of New York’s Hunter College explain why COVID-19 is nearly impossible to contain in such settings, and recommend urgent measures to reduce the loss of life. 

To illustrate the devastating effects of COVID-19 among persons detained in close quarters, the authors cite the 1918 influenza pandemic, when nearly half of all prisoners at California’s San Quentin jail fell ill. They also point to the recent case of passengers held on a luxury cruise ship, resulting in 700 COVID-19 infections and 12 deaths. They warn that prisons and jails today are even more crowded than San Quentin was in 1918 — and much less-resourced than a cruise ship — which will accelerate the COVID-19 epidemic both within prison walls and in nearby communities. 

The authors suggest urgent changes within carceral settings. These include better access to testing and treatment, medical isolation when necessary, and ensuring that inmates can access medical care without copayments. However, the top priority should be enabling social distancing by immediately shrinking the number of incarcerated persons. “Decarceration – getting people out of prison – is the way to prevent a catastrophe,” said senior author and associate professor at Harvard Medical School Dr. Danny McCormick. “Local governments and justice departments have made some changes, but too many people have been left in harm’s way.”  

The paper also provides recommendations to protect inmates after release. “The two weeks after release are a high-risk time,” said Dr. Laura Hawks, lead author and research fellow at the Cambridge Health Alliance. “Re-entry planning and support for housing, health care, food, and re-entry into the workforce are critical. Evidence shows that many prisoners can be safely returned to the community – and right now there’s a humanitarian imperative to do so.”

Study co-author Dr. Steffie Woolhandler, who is a Professor at CUNY’s Hunter College and co-founder of Physicians for a National Health Program added, “We believe that health care is a human right, as is freedom from cruel and unusual punishment. Both of these rights are being trampled in our prisons and jails.”  

“COVID-19 in Prisons and Jails in the United States,” Laura Hawks, M.D.; Steffie Woolhandler, M.D., M.P.H.; and Danny McCormick, M.D., M.P.H. JAMA Internal Medicine. Published online first, April 28, 2020. doi:10.1001/jamainternmed.2020.1856

Physicians for a National Health Program (PNHP) is a non-profit organization whose 23,000 members advocate for single-payer Medicare-for All; PNHP played no role in funding or conducting this analysis.

Contact: Dr. Laura Hawks, primary care physician and research fellow at Harvard Medical School and Cambridge Health Alliance, lhawks@challiance.org

Jan., 27, 2020 — More Americans have unmet health needs today than two decades ago, according to a new study from Harvard Medical School and the City University of New York at Hunter College. The study, published today in JAMA Internal Medicine, found that despite an increase in insurance coverage from the Affordable Care Act (ACA), the percentage of people who are unable to afford to see a doctor when needed has risen. This was especially true of people with serious medical conditions like heart disease, for whom physician care is essential. The largest relative increases in unmet health needs occurred among people who had had insurance, suggesting that deterioration in quality of private health insurance, not lack of insurance, caused most of the increase in unmet health needs over the last 20 years.

Using survey data from over 400,000 working age adults, the researchers compared responses in 1998 to responses to the same questions in 2017. Over the two decades, the share of non-elderly adults who were unable to afford to see a doctor has increased by nearly a third – from 11% to 16%. However, among those with health insurance coverage, the study found a 60% increase — from 7% to 12%. Overall, adults with a chronic disease had nearly a 20% chance of skipping a doctor visit due to cost in 2017 — 63% worse than 1998. The study also found no improvements in the likelihood of having a routine check-up among high-risk patients in 2017 as compared to 1998.

The study’s authors noted that private insurance has become less comprehensive as insurers have increased deductibles, coinsurance and copays. Meanwhile, many private insurers’ provider networks have narrowed, leading to the recently publicized phenomenon of “surprise medical bills” which may deter patients from seeking future care. While the study could not separate private insurance from public insurance programs such as Medicaid, Medicaid typically does not require cost sharing.

“Our findings call into question the value of private health insurance today,” said the study’s lead author, Dr. Laura Hawks, a Harvard research fellow and primary care physician. “When so many people can’t get the care they need even when they have insurance coverage, it says that insurance is not doing what it is supposed to do: ensure that health care is affordable when you need it.”

The new study also provides new insights into both the achievements and limitations of the ACA’s coverage expansions. Previous studies have established that these expansions improved both insurance coverage and the affordability of care for previously uninsured Americans. The new Harvard/Hunter College study suggests, however, that these gains didn’t counterbalance the long-term trend toward deteriorating access to needed medical care.

“The ACA was crucial for expanding coverage to low-income Americans, particularly the Medicaid expansion in states that allowed it,” said senior study author Dr. Danny McCormick, an associate professor of medicine at Harvard Medical School and primary care physician at the Cambridge Health Alliance. “However, because it did little to fix the biggest problems with private insurance — such as high copays and deductibles and narrow networks — the ACA didn’t reverse the long-term downward trend towards decreasing health care affordability.”

“Health coverage needs to be both universal and comprehensive, meaning that it covers everyone and that it pays in full for all medically necessary care,” commented study co-author, Dr. Steffie Woolhandler, a distinguished professor of public health at CUNY’s Hunter College and lecturer in medicine at Harvard Medical School. “Our private insurance-based system simply isn’t doing that.”

The study found improvement in a few types of preventive care since 1998; more Americans are receiving cholesterol checks and flu shots. However, fewer women are now receiving mammograms.

“Some aspects of health care are improving, but death rates are rising and we are mostly moving backwards on the health and health care of working-age adults, ” said study co-author Dr. David Himmelstein, a distinguished professor of public health at CUNY’s Hunter College and lecturer in medicine at Harvard Medical School. “A single-payer reform like Medicare-for-All that eliminates financial barriers to care is what patients need.”

* * * * * *

“Trends in Unmet Need for Physician and Preventive Services in the United States, 1998 to 2017,” Laura Hawks, MD; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH; David H. Bor, MD; Adam Gaffney, MD, MPH; and Danny McCormick, M.D., M.P.H. JAMA Internal Medicine. Published online first, January 27th, 2020. doi:10.1001/jamainternmed.2019.6538

Contact: Steffie Woolhandler, M.D., M.P.H., steffie_woolhandler@hms.harvard.edu
Adam Gaffney, M.D., M.P.H., agaffney@cha.harvard.edu
Clare Fauke, Physicians for a National Health Program, clare@pnhp.org

Physicians for a National Health Program (PNHP) today welcomed the American College of Physicians’ (ACP) endorsement of single-payer Medicare for All. The ACP, a national organization of 159,000 internists, is the largest medical specialty society and second-largest physician group in the U.S. after the American Medical Association (AMA). 

The ACP announced its endorsement of Medicare for All in a special supplement to its official journal, the Annals of Internal Medicine, where the group also endorsed a “universal public choice” reform model. 

The ACP endorsement coincides with the publication of an open letter signed by more than 2,000 physicians “prescribing” Medicare for All, an effort organized by advocates separately from the ACP. Among the “prescribers” are towering figures in American medicine, including Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine; Dr. Bernard Lown, developer of the defibrillator; Dr. Paul Farmer, infectious disease expert and founder of Partners in Health; and Dr. Mary Bassett, former New York City Health Commissioner. The letter will appear as an advertisement in the New York Times on January 21. 

Along with the ACP’s position paper, the Annals of Internal Medicine published an editorial by PNHP co-founders Drs. Steffie Woolhandler and David Himmelstein. Drs. Woolhandler and Himmelstein, noting that organized medicine had opposed national health insurance for a century, called the ACP’s new position “a sea change for the medical profession.”

The ACP’s endorsement of Medicare for All and the publication of the open letter reflects growing support for single-payer reform among physicians. Recent surveys have found that half of all doctors now favor national health insurance. Last June, the AMA’s House of Delegates only narrowly defeated a resolution that would have rescinded its long-standing opposition to Medicare for All. Under pressure from Medicare for All supporters, the AMA then resigned from the dark money group Partnership for America’s Health Care Future, which opposes single-payer reform. 

“As physicians, we see daily the harm that our fragmented, private-insurance based system does to our patients,” noted Dr. Adam Gaffney, President of PNHP and a pulmonary and critical care physician at Harvard Medical School and the Cambridge Health Alliance. “Patients go without the care they need, and physicians squander time and resources on wasteful billing and clerical tasks. Medicare for All would be a much better way — for patients and doctors both.”  

According to Dr. Woolhandler, a Distinguished Professor at the City University of New York at Hunter College and Lecturer in Medicine at Harvard Medical School, “When we started PNHP, doctors who supported single-payer reform were considered radicals, and reporters likened us to ‘furriers for animal rights’.  Now we’re squarely in the mainstream of the medical profession. More and more doctors have realized – often from talking to our Canadian colleagues – that single payer is the only way to cut insurers’ paperwork and profits that siphon hundreds of billions annually from care in the U.S.” Dr. Woolhandler is a Fellow of the ACP, but not an official spokesperson for that organization.

PNHP is a nonprofit research and education organization whose more than 23,000 members support single-payer Medicare for All reform. PNHP’s physician members have been working for single payer since publication of its policy proposal in the New England Journal of Medicine in 1989.

The following documents are available to credentialed media professionals upon request:

• “Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care,” by the Health and Public Policy Committee of the American College of Physicians, Annals of Internal Medicine, published online ahead of print January 20, 2020. doi:10.7326/M19-2415
• “The American College of Physicians’ Endorsement of Single-Payer Reform: A Sea Change for the Medical Profession,” by Steffie Woolhandler, M.D., M.P.H., and David Himmelstein, M.D., Annals of Internal Medicine, published online ahead of print January 20, 2020.

Contact:
Dr. Adam Gaffney, instructor in medicine, Harvard Medical School; President, Physicians for a National Health Program; Division of Pulmonary and Critical Care Medicine, Cambridge Health Alliance; agaffney@cha.harvard.edu
Clare Fauke, communications specialist, Physicians for a National Health Program, clare@pnhp.org

The rising price of prescription drugs has led to a slew of proposals to lower costs and expand access to medications. However, a new study from researchers at Harvard Medical School and the City University of New York at Hunter College suggests that an effective reform model already exists: the pharmacy benefit of the Veterans Health Administration, commonly known as the VA. Researchers found that VA patients are significantly less likely than other insured Americans to go without needed medications, skip doses, or delay filling prescriptions because they are unable to afford them. The study found that VA coverage also reduced racial and economic disparities in prescription drug access.

The VA buys drugs at relatively low cost by using a combination of regulations, bargaining with drug companies to reduce wholesale prices, and utilizing a national formulary. The VA can then afford to provide drugs to veterans with low — or no — patient copays. The investigators assessed whether this benefit design lowered “cost-related medication non-adherence” by analyzing national health surveys conducted from 2014 to 2017. Although VA enrollees were older, sicker, and poorer than other insured Americans, fewer (6.1% of enrollees) reported that costs caused them to go without any medication in the course of a year — compared to 10.9% of non-VA patients. The differences were even larger among patients with serious conditions like heart disease (6.1% vs. 14.4%) and chronic lung disease (6.4% vs. 19.9%).   

“We face a crisis in drug affordability,” noted senior author Dr. Danny McCormick, associate professor of medicine at Harvard Medical School and a primary care physician. “High copays and deductibles are forcing patients to skip their medications — even for serious illnesses like heart disease or lung disease — putting their health, and even their life at risk. The VA shows that there is a better way.”

Previous studies suggest that drug costs would be lower for Medicare if it were allowed to negotiate prices directly with drug companies and use a national formulary, as does the VA. Currently, Medicare’s drug benefits are only available through private plans, which often impose copays, deductibles, and co-insurance for drugs that can add up to thousands of dollars annually. VA enrollees instead pay at most $11 per prescription, and often less. The researchers found that while the VA prevented patients overall from skipping medications due to costs, it was especially beneficial for minority veterans and those with lower incomes.

“Our findings have important implications for the debate about the affordability of health reform,” noted Dr. Steffie Woolhandler, distinguished professor at the City University of New York’s Hunter College and lecturer (formerly professor) in Medicine at Harvard Medical School. “Both the House and Senate Medicare-for-All bills would borrow tools from the VA to cut drug costs, including price negotiations and a formulary. These steps could allow all Americans to afford their medications without burdensome copayments or deductibles,” she added.  

Dr. Adam Gaffney, a pulmonary and critical care physician at Harvard Medical School, noted that while a VA-like drug benefit model could save money, it could also improve patients’ health. “Today, we have better drugs  — more ways to help our patients — than ever before. But these drugs offer no help to patients who can’t afford to take them. By reforming how we pay for prescription medications, we can improve health outcomes, while bringing our drug spending in line with that of other rich nations.” 

“The Effect Of Veterans Health Administration Coverage On Cost-Related Medication Nonadherence,” by Adam Gaffney, MD, MPH; David H. Bor, MD; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH; and Danny McCormick, MD, MPH. Health Affairs, published online ahead of print January 6, 2020. DOI: 10.1377/hlthaff.2019.00481

Physicians for a National Health Program (www.pnhp.org) is a nonprofit research and education organization whose more than 23,000 members support single-payer national health insurance. PNHP had no role in funding or otherwise supporting the study described above.

A study published today in the Annals of Internal Medicine finds that health care bureaucracy cost Americans $812 billion in 2017. This represented more than one-third (34.2%) of total expenditures for doctor visits, hospitals, long-term care and health insurance. The study estimated that cutting U.S. administrative costs to Canadian levels would have saved more than $600 billion in 2017.

Health administration costs were more than fourfold higher per capita in the U.S. than in Canada ($2,479 vs. $551 per person) which implemented a single-payer Medicare for All system in 1962. Americans spent $844 per person on insurers’ overhead while Canadians spent $146. Additionally, doctors, hospitals, and other health providers in the U.S. spent far more on administration due to the complexity entailed in billing multiple payers and dealing with the bureaucratic hurdles insurers impose. As a result, hospital administration cost Americans $933 per capita vs. $196 in Canada. The authors note that in Canada hospitals are financed through lump-sum “global budgets” rather than fee-for-service, much as fire departments are funded in the U.S. Physicians’ billing costs were also much higher in the U.S., $465 per capita  vs. $87 per capita in Canada.

The analysis, the first comprehensive study of health administration costs since 1999, was carried out by researchers at Harvard Medical School, the City University of New York at Hunter College, and the University of Ottawa. The authors, who also performed the 1999 study, analyzed thousands of accounting reports that hospitals and other health care providers filed with regulators, as well as census data on employment and wages in the health sector. They obtained additional data from surveys of physicians and government reports.

The researcher found that administration’s share of overall U.S. health spending rose by 3.2 percentage points between 1999 and 2017, from 31.0 % to 34.2%. Of the 3.2 percentage point increase, most (2.4 percentage points) was due to the expanding role that private insurers have assumed in tax-funded programs such as Medicaid and Medicare. Private managed care plans now enroll more than one-third of Medicare recipients and a majority of those on Medicaid; Medicare and Medicaid now account for 52% of private insurers’ revenues. Private insurers’ increasing involvement has pushed up overhead in those public programs; private Medicare Advantage plans take 12% or more of premiums for their overhead, while traditional Medicare’s overhead is just 2%, a difference of at least $1,155 per enrollee (per year).

The authors cautioned that their estimates probably understate administrative costs, and particularly the growth since 1999. Their 1999 study included administrative spending for some items such as dental care for which no 2017 data were available.  Additionally, private insurance overhead has increased since the study’s completion, rising by 13.2% between 2017 and 2018 according to official health spending figures released in December.   

“Medicare for All could save more than $600 billion each year on bureaucracy, and repurpose that money to cover America’s 30 million uninsured and eliminate copayments and deductibles for everyone,” said study senior author Dr. Steffie Woolhandler, a distinguished professor at the City University of New York (CUNY) at Hunter College and lecturer in Medicine at Harvard Medical School, where she previously served as a professor. “Reforms like a public option that leave private insurers in place can’t deliver big administrative savings,” Dr. Woolhandler added. “As a result, public option reform would cost much more and cover much less than Medicare for All.”

According to Dr. David Himmelstein, the study’s lead author who is an internist in the South Bronx, a distinguished professor at CUNY’s Hunter College and lecturer in Medicine at Harvard, “Americans spend twice as much per person as Canadians on health care. But instead of buying better care, that extra spending buys us sky-high profits and useless paperwork. Before their single-payer reform, Canadians died younger than Americans, and their infant mortality rate was higher than ours. Now Canadians live three years longer and their infant mortality rate is 22% lower than ours.  Under Medicare for All, Americans could cut out the red tape and afford a Rolls Royce version of Canada’s system.” 

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“Health Care Administrative Costs in the United States and Canada, 2017.” David U. Himmelstein, M.D.; Terry Campbell, M.H.A.; and Steffie Woolhandler, M.D., M.P.H. Annals of Internal Medicine, published online ahead of print January 6, 2020
doi:10.7326/M19-2818

The Annals of Internal Medicine is the official journal of the American College of Physicians, the largest U.S. medical specialty society with 159,000 members.

In addition to their academic positions, Drs. Woolhandler and Himmelstein founded Physicians for a National Health Program, a 23,000 member organization that advocates for Canadian- style national health insurance in the U.S. Co-author Terry Campbell is Executive Director, Research Operations and Strategies at the University of Ottawa in Canada.