Physicians for a National Health Plan Mission: Universal, comprehensive, single-payer national health insurance
Plan StatusProposed. PNHP's National Health Insurance Bill (HR 676) was introduced to the House on 1/24/07; on 2/2/07 it was referred to the House Subcomittee on Health. The group is waging an ongoing campaign for the passage of the U.S. National Health Insurance Act into law.Number of People CoveredAll U.S. residents, including documented and undocumented immigrants.Estimated CostPNHP asserts that their plan would save enough administrative costs (more than $350 billion per year) to offset the cost of high-quality universal coverage.Payment SchemeThe plan would be funded by taxes and an increase in public health funding. Public funds already funneled to Medicare and Medicaid would be retained.
The gap between current public funding and what would be needed for a universal care would be financed by a payroll tax on employers (about 7%) and an income tax on individuals (about 2%). The payroll tax on employers would replace all other employer expenses for employees' health care. The income tax on individuals would take the place of all current insurance premiums, co-pays, deductibles, and other out-of-pocket payments.
Plan in Brief
PNHP advocates for a single-payer national health insurance plan. The organization focuses on this single issue and has a membership of more than 15,000 physicians, medical students, and health care professionals.
The proposed plan would insure all U.S. residents--including docmented and undocumented immigrants. It would cost less to administer than the existing for-profit system, which PNHP views as focused on the profits of investors and executives rather than on the care of patients.
The plan would be publicly administered by a health planning board made up of medical experts, and representatives of patients, providers, business, and government. The board would also allocate money for new investments and research.
The plan would cover, through the single payer,
all medically necessary care including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care, and dental care. The plan would also cover clinically-proven alternative care.
Impact on Federal Government
Under the proposed single-payer system, there would no longer be hundreds of private plans. There would be a single public plan--the government would be the only insurer for everyone.
Decisions about taxes, fees, and benefits would be made by the health planning board.
Impact on States
States would have a role in the proposed health planning board. A sample brochure on the PNHP's website indicates that each state would set up a public trust fund and that a board of appointed and elected members from throughout the state would administer the plan.
Impact on Insurers
Under the plan, there would be no more private insurers; rather, the single-payer plan be implemented through the government and health planning board.
There would be very little need for insurance workers. PNHP anticipates that re-training and placing these workers would cost about $20 billion, a small fraction of what they say will be saved in the transition to single-payer, national health insurance.
Impact on Providers
Under the plan, physicians would regain autonomy over patient care.
According to PNHP, physicians' incomes would change very little, however, the income disparity between specialties would probably shrink.
The increase in patient office visits would be offset by the reduction of paperwork and simpler billing system.
Providers would be given a method to negotiate fees. Under the plan, the health planning board, and not private for-profit insurers, would decide on reimbursement rates.
Impact on Employers
A payroll tax on employers of 7% means employers would pay less than they currently do (about 8.5%).
For employers who do not currently insure their workers, the payroll tax will mean a cost increase; for those who do insure their workers, the plan will represent substantial savings.
Health insurance would disappear from the bargaining table between employers and employees.
It's not clear whether employers will be able to purchase additional private insurance to cover what the national plan would not (e.g., private rooms, orthodontia), as is done in Canada. But PHNP advocates for a quality program that would eliminate the need for supplemental coverage.
Impact on Individuals
Under the plan, individuals would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs.
Patients would have free choice of doctors and hospitalsl doctors would regain autonomy over patient care. Patients would no longer be forced to see providers insisted upon by their insurers.
PNHP asserts that the plan would improve the health and longevity of Americans, as single-payer plans do in other countries.
The 2% income tax on inidividuals would reperesent less than what most now pay for private insurance, and PNHP asserts that they would recieve much more comprehensive care.
Proponents/Opponents
Proponents of a single-payer plan emphasize the benefits of quality coverage for all and equal access to treatment. Such a plan, they say, would place health care decisions in the hands of doctors and patients. They argue that such a system would be more efficient than any other: A single entity would collect all healthcare fees and pay out all healthcare costs. Healthcare providers (doctors, hospitals, etc.) would bill one entity (a single organization, or the government, for example) for services. Under the current system in the U.S., there are many insurance plans, tens of thousands of payers, tons of paperwork, and a complex billing system. PNHP and other advocates of a single-payer plan say that they would cut back on administrative waste and save money that could be applied to providing care.
Opponents of a single-payer plan argue that such a system would lower the quality of health care in the U.S. and hurt research and medical innovation. Many are against any type of publicly-funded care and negatively categorize the single-payer alternative as socialized medicine. Critics hope that through less radical reforms, the U.S. can improve quality and lower cost without going to a system where they believe the government would decide who is going to be treated, and who is not. Opponents back their position by pointing to single-payer programs in Europe, where they see a stifling of medical innovation and rationing of care.
Key Targets for Investment Not clear. PNHP predicts that the need for administrative organizations and workers will shrink dramatically and that these workers (and those from the insurance industry) would need job retraining and placement. However, more health care providers--especially in the fields of long-term care, home health care, and public health--would be needed.
Notable Feature
PNHP sees access to health care as a right of all people, one that should be provided as a public service and not bought and sold for profit.
The plan would cover all U.S. residents--including all documented and undocumented immigrants--and focus on accessibility.
PNHP favors immediate reform and opposes so-called "gradual steps" towards a single-payer plan now in place in some states.
Experts' Comments“I think single payer is the only morally acceptable reform choice, because it's the only effective one on the table....If we're concerned about the 18,000 deaths a year due to uninsurance, then we are morally obligated to go with a plan that has been shown to work."
-- Steffie Woolhandler
MD, MPH, PNHP Co-founder
“Leading Republicans propose tax incentives to encourage the uninsured to buy coverage, but these subsidies fall far short of the cost of adequate insurance. For cost control, they suggest high co-payments and deductibles. Yet these selectively burden the sick and poor, discourage preventive and primary care, and have little effect on costs, since seriously ill patients - who account for most health spending - quickly exceed their deductibles and are in no position to forego expensive care.“
-- PNHP from "An Open Letter to the Presidential Candidates";
“The incremental changes suggested by most Democrats cannot solve our problems; further pursuit of market-based strategies, as advocated by Republicans, will exacerbate them. What needs to be changed is the system itself.“
-- PNHP from "An Open Letter to the Presidential Candidates";
Interest Groups 
