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Full Proposal

Supplemental Materials

Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform establishes the vision and principles that will empower Americans to replace our expensive, inadequate, and inefficient collection of health care systems with an improved Medicare for All.

The proposal outlines the general structure of a single-payer system for the United States, including coverage and eligibility; physician and outpatient care payment; global budgeting of hospitals; health planning and capital investments; coverage for medications, devices, and supplies; the establishment of a national long-term care program; cost-containment; and single-payer financing. The proposal also demonstrates the shortcomings of alternatives to National Health Insurance, including the Affordable Care Act.

- Download the full proposal as a PDF document or read the proposal on our website.
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Endorse the proposal, either as a physician / medical student, or as a non-physician health professional / reform advocate outside the health professions.
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Read a summary of the proposal and an associated fact sheet on health care in the United States. Also, note the number of uninsured by state as of 2014.
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Record a short video testimonial in support of the proposal. To view sample testimonials, please visit our YouTube page.
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Read an editorial written by the proposal’s authors and consider writing your own op-ed.
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Read the press release announcing the publication of the proposal in May 2016 or access content from the introductory news conference.
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Read prepared statements by PNHP president Robert Zarr, M.D.; PNHP co-founder and proposal co-author Steffie Woolhandler, M.D., M.P.H.; proposal co-author Adam Gaffney, M.D.; and Karen Higgins, R.N. of National Nurses United; as well as transcribed remarks by PNHP national coordinator Claudia Fegan, M.D. and Sidney Wolfe, M.D. of Public Citizen.
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Support the movement for single payer in the United States by joining PNHP or by making a financial donation.
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We are confident that the Physicians’ Proposal points the way toward a more comprehensive, efficient, and humane health care system. With your help, we can make single payer a reality and ensure quality, affordable health care for all.

Media Coverage

Overview of H.R. 676

Read the full text of H.R. 676 (or access a brief summary of the bill)

Read PNHP’s news release, and the news release from lead sponsor Keith Ellison (D-Minn.)

Compare H.R. 676 to the ACA (and to the short-lived GOP “replacement” bill)

List of cosponsors of H.R. 676 in the current (115th) Congress

List of organizations and governmental bodies endorsing H.R. 676 and single payer

Activism on H.R. 676

Visit PNHP’s Get Active page

Call your representative.
Click here for a list of current cosposnors (to thank) and likely cosponsors (to contact).

Write a letter to your representative.
Click here to send an editable letter to your member of Congress.

Ask your representative to join the Medicare for All Caucus.
Click here to send an editable letter to your member of Congress.

Financing a single-payer national health program

Funding H.R. 676: Executive Summary
(Friedman, University of Massachusetts-Amherst; July 2013)

“Liberal Benefits, Conservative Spending”
(Grumbach, et al., JAMA 265(19); May 15, 1991)

How Much Would a Single-Payer System Cost?

The Current and Projected Taxpayer Shares of U.S. Health Costs
(Himmelstein and Woolhandler, American Journal of Public Health, 2015)

A Comparison of Hospital Administrative Costs in Eight Nations
(Himmelstein et al., Health Affairs, Sept. 2014)

Transitioning to single-payer national health program

Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform
(Working Group on Single-Payer Program Design, American Journal of Public Health 106(6); June 2016)

A National Long-term Care Program for the United States; A Caring Vision
(Working Group on Single-Payer Program Design, JAMA 266(21); December 4, 1991)

A Better-Quality Alternative: Single-Payer National Health System Reform
(Working Group on Single-Payer Program Design, JAMA 272(10); September 14, 1994)

Cosponsor Target

Conservative Case for Single Payer

Speakers Bureau

For 35 years, Physicians for a National Health Program (PNHP) has provided thought leadership and evidence-based solutions to the problems plaguing the U.S. health system. PNHP leaders have published research and commentary in publications such as JAMA, Health Affairs, The Lancet, and The New England Journal of Medicine. We have also provided policy advice for members of Congress, as well as testimony for U.S. House and Senate hearings.

PNHP speakers are available in every region of the U.S., and are prepared to speak on a wide range of health policy topics, such as:

Single-payer Medicare for All: How it works and why it’s needed
Racial health inequities
The privatization on Medicare and other publicly-funded health programs
Mental health and addiction care
America’s rural health care crisis
Reproductive health care in the post-Roe era

To request a PNHP speaker at your institution, please fill out our Grand Rounds request form. If you have questions about our Speakers Bureau, or wish to schedule a speaker for a public event (not a Grand Rounds), please contact us at organizer@pnhp.org or call our national office at (312) 782-6006.

Bios for select national and regional PNHP speakers appear below. Additional speakers are also available, spanning a range of specialties and geographic locations.

For the Press

PNHP has background information on single payer for the press posted here.

If you are a member of the media and wish to speak with one of our members regarding improved Medicare for all, please contact our communications specialist, Gaurav Kalwani, at gaurav@pnhp.org.

Dr. Adam Gaffney on “Democracy Now”

Wendell Potter on MSNBC

Wendell Potter on MoveOn

For a complete archive of PNHP press releases, click HERE.

About PNHP

Physicians for a National Health Program is a single-issue organization advocating a universal, comprehensive, single-payer national health program. PNHP has more than 25,000 members, and chapters across the United States.

Since 1988, we’ve advocated for reform in the U.S. health care system. We educate physicians and other health professionals about the benefits of a single-payer system–including fewer administrative costs and affording health insurance for the 30 million Americans who have none.

Our members and physician activists work toward a single-payer national health program in their communities. PNHP performs ground breaking research on the health crisis and the need for fundamental reform, coordinates speakers and forums, participates in town hall meetings and debates, contributes scholarly articles to peer-reviewed medical journals, and appears regularly on national television and news programs advocating for a single-payer system.

PNHP is the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program.

Latest News

Case Study: Meeting With Legislators in D.C.

By Eric Naumburg, M.D.
Physicians for a National Health Program – Maryland

On March 29, 2017, several dozen health care activists undertook a project at the U.S. Capitol; the goal was to drop off information about improved Medicare for all to each of the 535 U.S. senators and representatives.

Our purpose was to collect contact information for each health care legislative assistant (LA) and build a database for future communications. Health Over Profit organized the day and the database is available on their website here; use it to contact you legislator.

We went in teams of two or more and divided up each building by floors. We visited each office, introduced ourselves, identified the group we represented, and told the staff person that we wished to leave information about improved Medicare for all for the health care legislative assistant. The handout was a one-pager that was formatted so that it was a quick read.

In some offices; we asked to speak with the LA or the senator/representative if they were available. This can be time consuming, but it did lead to some interesting exchanges. In general, the staff at the front desk are very polite. The LA business cards are usually sitting at the front desk. Only one door was locked: House Speaker Paul Ryan’s.

If you want to speak to specific legislator or their aide it is better to call the office and set up an appointment. Even if you have an appointment with a legislator, you may end up talking to the aide because when Congress is in session, legislators don’t have control of their daily schedules. Be prepared to leave a handout, as well as your business card, and practice what you want to say. Be sure to follow up at a later date!

Getting more co-sponsors for H.R. 676, the “Expanded and Improved Medicare for All” was not our primary goal. For co-sponsors of H.R. 676, we thanked them for their support and urged them to speak with their colleagues about becoming co-sponsors.

Photo: On the way to the Senate, 435 down, 100 to go.

The conservative case for single payer

Efficient. Effective. Practical. Make no mistake, there is a strong conservative case to be made for single payer. This is important because, as our health care crisis deepens, we need to make sure we’re speaking to all Americans. Only then can we can build a broad-based movement that pressures Congress to do the right thing.

To date, no Republican has co-sponsored H.R. 1384, the Medicare for All Act of 2019, nor did any Republican co-sponsor H.R. 676, the previous single-payer bill in the House. In order for this to happen, members need to hear from their constituents. If you live in a red district, we encourage you to call (202) 224-3121 today. (Click here to find your member of Congress.)

When speaking with a conservative member of Congress – or a conservative colleague, friend, or family member, for that matter – keep the following in mind:

Know your audience

Many single-payer advocates argue that “health care is a human right,” but conservatives may be more persuaded by appealing to the values of loyalty, sanctity, and authority. Dr. Ed Weisbart gave an excellent talk recently, titled Progressive Persuasions: Speaking Beyond the Choir, that explores this topic in detail (see video below).

Dispel common myths

Myth: Single payer is socialized medicine!
Reality: Medicare-for-all applies the principles of the free market to the delivery of health care. Under traditional Medicare, doctors and hospitals compete to attract patients through service, quality, and access – rather than competing to be in the best-reimbursed insurance plans. Medicare-for-all would open up this patient-centered free market to all Americans.

Myth: Single payer would lead to rationing!
Reality: Today’s private health insurance is incredibly restrictive, with narrow provider networks, cost-sharing, and a growing list of treatments that simply aren’t covered. Private insurance comapnies have a financial incentive to deny care, and they often do. Medicare-for-all would make it much easier for patients to access medically necessary care.

Myth: Single payer would stifle innovation!
Reality: Americans are justifiably proud of our nation’s leadership in medical innovation, but may not realize that most of those innovations are paid for using public funds. As pharmaceutical companies engage in trivial research designed to extend patents, our National Institutes of Health funds truly pioneering work. Medicare-for-all would strengthen the alignment of research with our most pressing health needs.

Expose the Canadian boogeyman

Some of the most pervasive myths about single payer relate to Canada’s Medicare program. Many Americans have heard that Canadians suffer long wait times, and flock to the United States to seek medical care. Thankfully, these myths are easily disproven. Consider the following:

• The 2002 Health Affairs study Phantoms in the Snow found that an exceedingly small number of Canadians seek care in the U.S.

• Waiting lists in Canada can be primarly attributed to lower health spending. Despite this, Canadians do not have to wait to be treated for life-threatening diseases and report fewer unmet health needs overall (see this NBER paper, Table 12).

• Former Canadian Medical Association Journal editor-in-chief and one-time market proponent David Woods says single payer is essential to controlling costs.

• George Mason University law professor Frank Buckley believes Republicans should embrace single payer, and points to the benefits of Medicare in his native Canada.

• Bottom line? Canadian health outcomes are better than American health outcomes, including longer life expectancy and fewer chronic conditions. These gaps have been growing ever since Canada fully implemented its Medicare program in the early 1970s.

Cutting overhead and bureaucracy

Your conservative representative may agree with you that single payer would provide high-quality care, but they may also also argue that the private sector is more efficient than the federal government, and therefore a better steward of our health care dollars.

However, it is our current, market-oriented system that generates the greatest amount of waste and profiteering. Conservatives who hate bureaucracy should be champing at the bit to do away with private insurance company overhead. A February 2017 estimate published in the Annals of Internal Medicine found that single payer would generate $504 billion in administrative savings annually.

Economists and public health experts have consistently shown that single payer is an efficient and effective use of resources. Here are some prominent examples:

• PNHP co-founders, Drs. David Himmelstein and Steffie Woolhandler, argue that single payer would allow for Liberal Benefits, Conservative Spending.

• Nobel laureate Angus Deaton favors single payer “because it will get this [health care] monster that we’ve created out of the economy and allow the rest of capitalism to flourish.”

• Nobel laureate and noted health care economist Kenneth Arrow lauds the Canadian system (with its private practitioners) and says single payer is “better than any other system.”

Boosting American business

Conservative members of Congress often voice concern over the global competitiveness of American business, and rising health care costs are harmful in that regard. Under single payer, U.S. firms might contribute as much to health care as they do now via a payroll tax, but they would no longer need to shop for group policies. They would also be spared the outrageous annual cost increases that have become commonplace in the large- and small-group markets.

For workers, single payer would allow those who are not a good fit for their jobs to seek more productive employment elsewhere instead of staying put in order to preserve health benefits. And would-be entrepreneurs would no longer fear striking out on their own due to a lack of health insurance.

Ultimately, improved Medicare-for-all would ensure a healthier, more financially-secure workforce. Thankfully, employers are starting to take notice:

• The group Business Leaders Transforming Healthcare “strongly supports legislation to transition the United States to a publicly funded health care system.”

• MCS Industries founder and owner Richard Master has produced a documentary, FIX IT: Health Care at the Tipping Point, that lays out the business case for single payer.

• Berkshire Hathaway vice-chairman (and longstanding Republican) Charlie Munger says single payer is the solution to America’s health care woes.

• Marks Group owner and prominent blogger Gene Marks considers himself a “smaller government, fiscally right-of-center guy,” but has concluded that single payer would be best for business.

Conservative voters are embracing single payer

Now that Congressional Republicans have unveiled the American Health Care Act, a growing number of their supporters are recognizing the empty promise of “repeal and replace.” They are demanding real reform, as evidenced by an April 2017 Economist/YouGov poll that found 46% of Republicans and 40% of Trump voters favor “Expanding Medicare to provide health insurance to every American.”

Single-payer reform is vitally important, and progressives can’t go it alone. Talk to your conservative friends, colleagues, family members, and elected officials. Listen to their concerns. Let them know that a humane, efficient, high-quality health care system is possible, but only if we work together.