Executive Summary

The United States spends more than twice as much on health care as the average of other developed nations, all of which boast universal coverage. Yet over 42 million Americans have no health insurance whatsoever, and most others are underinsured, in the sense that they lack adequate coverage for all contingencies (e.g., long-term care and prescription drug costs).

Why is the U. S. so different? The short answer is that we alone treat health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to medical need. In our market-driven system, investor-owned firms compete not so much by increasing quality or lowering costs, but by avoiding unprofitable patients and shifting costs back to patients or to other payers. This creates the paradox of a health care system based on avoiding the sick. It generates huge administrative costs, which, along with profits, divert resources from clinical care to the demands of business. In addition, burgeoning satellite businesses, such as consulting firms and marketing companies, consume an increasing fraction of the health care dollar.

We endorse a fundamental change in America’s health care – the creation of a comprehensive National Health Insurance (NHI) Program. Such a program – which in essence would be an expanded and improved version of Medicare – would cover every American for all necessary medical care. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHI to cover all operating costs. Investor-owned facilities would be converted to not-for-profit status, and their former owners compensated for past investments. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

A National Health Insurance Program would save at least $150 billion annually by eliminating the high overhead and profits of the private, investor-owned insurance industry and reducing spending for marketing and other satellite services. Doctors and hospitals would be freed from the concomitant burdens and expenses of paperwork created by having to deal with multiple insurers with different rules – often rules designed to avoid payment. During the transition to an NHI, the savings on administration and profits would fully offset the costs of expanded and improved coverage. NHI would make it possible to set and enforce overall spending limits for the health care system, slowing cost growth over the long run.

A National Health Insurance Program is the only affordable option for universal, comprehensive coverage. Under the current system, expanding access to health care inevitably means increasing costs, and reducing costs inevitably means limiting access. But an NHI could both expand access and reduce costs. It would squeeze out bureaucratic waste and eliminate the perverse incentives that threaten the quality of care and the ethical foundations of medicine.

Marcia Angell, MD Spokesperson Past Editor New England Journal of Medicine Quentin Young, MD Convener National Coordinator Physicians for a National Health Program Past President American Public Health Association Joel Alpert, MD Past President American Academy of Pediatrics  Ron Anderson, MD President and CEO Parkland Health & Hospital System Peter Beilenson, MD, MPH Commissioner Department of Health, Baltimore City Olveen Carrasquillo, MD, MPH Advisory Committee Member National Hispanic Medical Association Christine Cassell, MD Past President American College of Physicians Elinor Christiansen, MD President Elect American Medical Women’s Association Gary Dennis, MD Past President National Medical Association

Merlin Du Val, MD Former Assistant Secretary for Health Department of Health, Education and Welfare David Himmelstein, MD Co-Founder Physicians for a National Health Program Rodney Hood, MD  President National Medical Association Edith Rasell, MD, PhD Director Economic Analysis and Research Network Economic Policy Institute Helen Rodriguez-Trias, MD Past President American Public Health Association Sindhu Srinivas, MD National President American Medical Student Association Gerald Thomson, MD Past President American College of Physicians Walter Tsou, MD, MPH Commissioner  Department of Health, Philadelphia Steffie Woolhandler, MD, MPH Co-Director Center for National Health Program Studies The Cambridge Hospital/Harvard Medical School

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*The participants hold a number of distinguished positions, which are not limited to those listed above. The participants’ positions and affiliations listed here are provided for identification purposes only.

Former Editor of the New England Journal of Medicine is Leading Spokesperson for Effort

Washington, D.C. – A group of nearly two-dozen nationally prominent physicians — including Dr. Marcia Angell, former editor of the New England Journal of Medicine, Dr. Rodney Hood, the President of the National Medical Association which represents African-American physicians, Dr. Elinor Christiansen, the President of the American Medical Women’s Association, Dr. Merlin DuVal, President Nixon’s Assistant Secretary for Health, Drs. Christine Cassel and Gerald Thompson, Past Presidents of the American College of Physicians, Dr. Sindhu Srinivas, President of the American Medical Student Association, and other physician leaders — testify before Congress today that only comprehensive reform of America’s ailing health system will address the nation’s health care crisis. The hearing is sponsored by the Congressional Black Caucus, the Congressional Progressive Caucus, and the Congressional Hispanic Caucus.

“We’ve engaged in a massive and failed experiment in market-based medicine in the U.S.” said Dr. Marcia Angell. “Rhetoric about the benefits of competition and profit-driven health care can no longer hide the reality: Our health system is in shambles. Despite spending twice as much on average on health care per person as Sweden, Norway, Denmark, Canada, Australia, Japan and every other developed country, over 42 million Americans have no health care insurance at all, and tens of millions more are not covered for all their medical needs. The recession we all fear could easily push the number of uninsured to 60 million.”

Dr. Angell is the spokesperson for a collaboration by the nation’s top physicians who believe that a national health program is needed to improve the quality of the U.S. health system – recently ranked 37th by the World Health Organization. The physicians’ consensus proposal begins “Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right,”(Cardinal Joseph Bernardin). ”

More than 60 years ago, the National Medical Association was the only physician organization that supported single-payer, national health insurance” said Dr. Rodney Hood, President of the NMA. “In a diverse country such as ours, full of resources and ingenuity to unravel the mysteries of the human genome, there is no acceptable reason for Americans of any race, ethnicity or economic background to be barred from accessing the health care services they need. It is clear that Americans want health coverage that is affordable, accountable, and equitable.”

The group of eminent physicians will testify that national health insurance – essentially, Medicare for all — is the only way to control skyrocketing health costs while restoring choice of physician and the doctor-patient relationship. “We have the cruel paradox of rationing health care in the midst of plenty,” said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program (PNHP) and a Past President of the American Public Health Association. “With national health insurance we could reclaim the 25% of all health spending we currently squander on paperwork and use it to cover the uninsured.”

Tax credits, vouchers and medical savings accounts are failed strategies for reform, according to the Physicians’ Working Group. They would mostly benefit healthy and well-off Americans. “We don’t need any more piecemeal strategies that are, in effect, tactics by the drug and insurance industries to delay real reform,” said Dr. Young. “We need a system in which we have ‘everybody in, nobody out.”

Summary by Ellen Schaffer, Ph.D., MPH, with Ida Hellander, MD

As many of you know, the Congressional Progressive Caucus, Black Caucus, Hispanic Caucus, and the Congressional Universal Health Care Task Force, sponsored a hearing on universal, single payer, national health insurance from 10 a.m. to 3 p.m. on May 1, 2001. An impressive array of speakers and members of Congress appeared, and at the end, Representative Conyers (D-MI) declared it was “best hearing on health care ever held in the Congress.”

You can view the entire hearing on the web at the Kaiser Family Foundation website. The listed url is: www.kaisernetwork.org/healthcast/uhcb/may01. Alternatively, go to www.kaisernetwork.org/. Click on “view healthcasts,” then “calendar,” then look at the May 1 listing and click on “Progressive Caucus Universal Health Care.” A transcript is also on-line there.

What happened: Three notable trends

1. There is strong and committed leadership from active, progressive members of Congress for advancing health care reform in this session.

2. Support for comprehensive reform is broadening among communities of color, doctors, union members, patients, providers, and advocates.

3. There is growing recognition that market-based solutions are failing, but the battle lines are being drawn between the current administration, which is determined to further privatize Medicare and other public programs, and advocates of effective, single payer reform.

The progressive House leadership signaled their serious commitment to universal, comprehensive single payer health care reform, by their statements and by their presence throughout the day. Progressive Caucus chair, Rep. Dennis Kucinich (OH), vice-chair Rep. Barbara Lee (CA), and Rep. John Conyers (MI) engaged the participants for nearly five hours, and Rep. Donna Christensen (Virgin Islands), chair of the Black Caucus health committee, stayed for most of the proceedings. Twelve members of Congress attended, and many stayed for several hours, a truly significant turnout.

The three panels

Robert Reich, former Secretary of Labor, led off the proceedings with a statement.

Dr. Marcia Angell, former editor of the New England Journal of Medicine, presented a White Paper prepared by the Physicians’ Working Group for Single-Payer National Health Insurance, a group organized by PNHP National Coordinator and APHA Past-President Dr. Quentin Young. The paper is available at the web site of Physicians for a National Health Program at www.pnhp.org under “News and Updates.” Dr. Angell’s clear and compelling presentation that universal single payer national health insurance is both imperative and affordable received a standing ovation from the members and the audience.

In addition to Dr. Angell, members of the Physicians Working Group for Single-Payer National Health Insurance come from a wide array of physician organizations and backgrounds: Dr. Rodney Hood, the President of the National Medical Association which represents African-American physicians; Dr. Elinor Christiansen, the President of the American Medical Women’s Association; Dr. Merlin DuVal, President Nixon’s Assistant Secretary for Health; Drs. Christine Cassel and Gerald Thompson, Past Presidents of the American College of Physicians; Dr. Sindhu Srinivas, President of the American Medical Student Association; APHA Past President Dr. Quentin Young, Philadelphia Health Commissioner Dr. Walter Tsou, APHA Past-President, Dr. Helen Rodriguez-Trias, the Economic Policy Institute’s Dr. Edith Rasell, Dr. Olveen Carasquillo, Universal Health Care Task Force of the National Hispanic Medical Association, Dr. Peter Beilenson, Baltimore City Health Commissioner, and PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler.

During the second panel, members of Congress spoke about their own legislative proposals.

Reps. Kucinich and Conyers announced their intentions to work together to draft a new bill for single payer national health insurance.

Rep. Barbara Lee spoke eloquently about HR 3000, the U.S. Universal Health Service Act, which she will re-introduce, and its importance both for public health and for redressing health care inequalities.

Rep. Jesse Jackson Jr. (IL) made an impassioned presentation about his proposed resolution to make health care a constitutional right.

Other speakers included Reps. Ciro Rodriguez (TX), Tammy Baldwin (WI), John Tierney (MA), and Pete Stark, Hilda Solis, and Bob Filner (all CA).

The third panel included other supporters of universal health care, who presented their personal experiences as health care providers, patients, and analysts to dramatize the need for universal health care.

Ellen Shaffer, a founding member of the APHA Working Group on Universal Health Care, discussed the importance of a publicly accountable and public financed universal system to provide access and coordinated, high quality care for immigrant workers in California, women with breast cancer, and high-risk infants. APHA members Donald Light, Claudia Morrissey, Nancy Milio, Mary Villedrouin, Thelma Correll, Carmen Nevarez, Karyn Pomerantz, Mark Hannay, and Susan Reverby, and Barbara Brenner, contributed to her statement.

Other providers and patients represented the American Psychological Association, the Service Employees International Union, the Black Nurses Association, the League of Women Voters, the Massachusetts Nurses Association, the Black Health Care Brain Trust, people with sickle cell anemia and cancer. A doctor protested the recent closing of DC General Hospital. Frank Clemente of Public Citizen’s Congress Watch presented a critique of the Breaux-Frist proposal to privatize Medicare.

The audience for the hearings were as impressive as the panelists, including among others: Bob Griss, Executive Director, Center on Disability and Health, and APHA Executive Director Mohammed Akhter; Kevin Lindamood of Health Care for the Homeless; Gail Shearer of Consumers Union; Madeleine Gold of SEIU; and many Congressional staff, including Cathy Hurwit, staff for Rep.Jan Schakowsky, and staff for Sen. Paul Wellstone. The hearing room was packed and enthusiastic.

Significance of the event

PNHP National Coordinator Dr. Quentin Young’s extraordinary energy and vision, combined with excellent staffing by PNHP assistant Jackie Le, brought together a wide-ranging group of doctors in support of a single payer health care system, and gave our champions in Congress like Reps. Kucinich, Lee, Conyers and Christensen a platform for action on single payer national health insurance, which was endorsed before the hearing by both the Progressive and Black Caucuses. This diversity was reflected in the participation of the Black and Hispanic Caucuses, and the range of advocates for reform who spoke at and attended the hearing.

It was remarkable that these members of Congress devoted almost five hours on a working day to listening to moving and effective testimony. Thanks to Congressional staff Joel Segal, Allison Friedrich, and Danielle LeClair for their dedication to this project.

As the discussion on the Breaux-Frist Medicare proposal reminded all of us, our vision is not driving national policy, and in fact supporters of the failing market approach are pushing hard and fast to undermine public programs in the U.S. and to export privatization abroad. It is more critical than ever to show our support for those courageous and visionary members of Congress who are standing up to lead the way, by mobilizing our organizations, and encouraging our representatives to co-sponsor progressive legislation, including the upcoming new Conyer’s bill for single payer national health insurance and to join the Universal Health Care Task Force.