Health Care for All

HEALTH CARE FOR ALL
A Single-Payer, Community-Based Health Service
Universal, Comprehensive Coverage
All medically necessary services, including rehabilitative, long-term, and home care, dental, optical, and mental healthcare, prescription drugs, and medical supplies; and preventive and public health measures.
Free at the point of delivery; No out-of-pocket payments
Co-payments and deductibles are barriers to access, administratively unwieldy, and unnecessary for cost containment.
Free Choice of Providers
Patients are free to seek care from any licensed health care provider.
A Single Public Payer
Private insurance costs more, wasting of billions of dollars on useless paper pushing, marketing, excessive executive salaries, and profits. Single payer systems in other countries and our experience with Medicare and the Veterans Administration show public systems are more efficient.
Lower Costs
A progressive taxes to finance health care will cost less in taxes for 95 percent of New Yorkers than they now pay in taxes plus insurance premium, co-pays, and deductibles. Overall health care expenses will be reduced due to administrative efficiencies.
Democratic Community and Worker Control  –  Not Corporate Dictates
The public has an absolute right to democratically set overall health policies and priorities, but medical decisions must be made by patients and providers rather than dictated from afar. Market mechanisms principally empower employers and insurance bureaucrats pursuing narrow financial interests. Local health boards elected by the public and by health workers will administer the local health service and elect a regional and state boards to administer the regional and statewide programs.
Global Operating Budgets with Separate Allocation of Capital Funds
Billing on a per-patient fee-for-service basis creates unnecessary administrative complexity and expense. Each hospital, clinic, and care facility will operate under a global operating budget. A budget separate from operating expenses will be allowed for capital improvements. With doctors on salary instead of the income-maximizing fee-for-service piece-work system, budgeting can redress a number of problems in our present health care system, including the shortage of primary care doctors, the bias toward acute curative care over preventive care, and the inequitable geographic and class-based distribution of health resources.
Ban on For-Profit Health Care Providers
Profit seeking inevitably distorts care and diverts resources from patients to investors
Just Transition for All Health Care and Insurance Workers
A single-payer health program would eliminate the jobs of tens of thousands of people who currently perform billing, advertising, eligibility determination, and other superfluous tasks. These workers will be guaranteed income, retraining, and placement in meaningful new jobs. Many of these workers will be needed to deliver health care in clinical settings instead of the determining eligibility for care in insurance offices.
The federal health care reform enacted in March 2010 mandates the purchase of private health insurance by individuals who do not qualify for public health care programs. The federal reform will not control costs, increase access, or, most importantly, improve the people's health.
The federal reform is built around a set of back room deals which the Obama administration made with big drug, insurance, and hospital corporations. These corporations have every incentive to increase profits by diverting resources from medical care. The federal health care reform only entrenched the enormously inefficient and ineffective health care system that is already in crisis. The crises of cost, access, and outcomes will only worsen in the years ahead if we do not create a non-profit health care system funded by a single public payer.
With reform at the federal level blocked for the time being, it is time to take the initiative at the state level. New York State should enact a single payer health care plan and seek a federal waiver from the new federal system.
A single public plan will provide access to comprehensive health care services for every New Yorker while saving New Yorkers billions of dollars a year. The New York State Department of Health and Department of Insurance contracted with the Urban Institute to compare 4 options for health reform in the state, including single payer (“Public Health Insurance for All”). The results of the two-year study released in July 2009 showed that single payer was the only plan that would cover everyone and was the most effective plan at controlling costs. The report found that the savings from single payer would substantially increase over time. By 2019, the Urban Institute analysis showed that single payer would save $20 billion annually compared to the present system. Single payer would cost $28 billion less annually than an individual mandate plan like the federal reform enacted in March 2010.
Even better than single-payer health insurance would be a single-payer health service. Single payer insurance with private delivery fails to decouple major drivers of health care inflation: the fee-for-service payment system and the profit maximizing of for-profit health care delivery. While single payer insurance would be an improvement over the costly system of mixed public and private programs we now have, without also bringing the delivery of health care under public control, public health insurance will simply guarantee private health care profits without effective cost controls.
A federally funded study administered by the California's state Health and Human Services Agency looked at nine health care reform options in California in 2002, including two single payer insurance models and a single payer health service model. The single payer models were the only ones that saved money while providing universal coverage, with the health service model scoring best overall on cost, public accountability, and quality of care.
In a community-based health service, salaried physicians and other health workers would provide care in publicly budgeted nonprofit group practices. It would be democratic and responsive, governed from the bottom up by community health boards elected by local residents (two-thirds of board members) and health workers (one-third of board members). A single-payer health service would cost even less than single-payer health insurance because it eliminates the other inflationary cost drivers: fees-for-service and profit-maximizing providers. Prospective budgets for community health boards on a per capita basis, in place retrospective fee-for-service reimbursements by third-party insurance, would enable the correction of other major health system problems: the shortage of primary care doctors, the bias toward acute curative care over preventive care, and the inequitable geographic and class-based distribution of health resources.
We need a Universal Health Service funded by progressive income taxes and payroll taxes (social insurance) and paying the salaries and operating budgets of health care providers and their practices to delivery all medically necessary services to every New York resident. Progressive taxes can fund a Universal Health Service at significantly less cost than what both families and businesses now pay in taxes, insurance premiums, and out-of-pocket expenses. This reform would also provide huge relief to county budgets by eliminating their health care costs, especially Medicaid.
The predatory economic dynamic of our profit-oriented health care system is cannibalizing the rest of the economy. Health care spending now accounts for 17 percent of GDP and has grown at three times the rate of inflation for the last decade. Since 1999, employment-based health insurance premiums have increased 120 percent, compared to cumulative inflation of 44 percent and cumulative wage growth of 29 percent during the same period. Administrative costs and profits account for 31 percent of spending in private health insurance sector, compared to the 3.6 percent overhead for Medicare.
The US spends twice as much per person on health care as any other country in the world, but ranks 37th in health care outcomes, according to the World Health Organization.
47 million people are now uninsured and tens of millions more are underinsured. 62 percent of personal bankruptcies are due to medical bills and 68 percent of these people had health insurance.
The health care system is not delivering the medical care it should and it is bankrupting our country. We need to make health care a public service, not a profit-maximizing business. We need fundamental reform of both the payment system and the delivery system.
On the payment side, we need a single public payer through a Universal Health Service. The savings from administrative efficiencies would save enough to cover every New York resident with a comprehensive set of benefits covering all medically necessary services, including:
· Primary care
· Inpatient care
· Outpatient care
· Emergency care
· Prescription drugs
· Durable medical equipment
· Long term care
· Mental health services
· Dentistry
· Eye care
· Chiropractic
· Substance abuse treatment
Patients would have their choice of physicians, providers, hospitals, clinics, and practices. Patients would never pay co-pays or deductibles. The Universal Health Service would pay health care providers' salaries and operating budgets. The savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all New Yorkers.
On the delivery side, we need to replace the fee-for-service system with salaried staff. Ninety-five percent of health care workers are already on salary. But the piecework system of fee-for-service builds in incentives for providers to maximize patients and procedures in order to maximize income under any system, single payer or multi payer, non-profit or especially for-profit. Without replacing fee-for-service with salaries, we will not contain costs in the long run. That is why we need a Universal Health Service (not just universal health insurance) where physicians and other staff work for a salary and not fees-for-service where specialties and volume bring in the most income at the expense of primary care and time for quality communication with patients.
The Universal Health Service would do more than simple provide universal "coverage," an insurance term meaning simply that health care costs would be "covered" for every U.S. resident.  It goes beyond this by ensuring that not only that health services would be paid for, but also that they would be available where and when users need them. Through funding of community and regional health services in all parts of the state, on a per capita basis, it would ensure that services were available to every resident.
Salaried physicians and other staff would work in non-profit, multi-specialty group practices.  The Universal Health Service would only fund services provided by publicly owned salaried group practices, on the model of the Veterans Administration in the US and public health services in the UK, Denmark, Cuba, and Costa Rica, or by non-profit organizations with salaried staff like the Group Health Cooperative in Seattle and the Mayo Clinic in Minnesota.
A decentralized federation of community health boards (one of each 25,000 or so people) elected by health care consumers and workers would govern the Universal Health Service. The community boards would send representatives to regional (metropolitan) and state boards where regional and state budgets and policies would be developed. This structure provides a community-based system -- controlled from the bottom up by those who use the system and those who work in it. The system has a budget, not an open-ended fee-for-service guarantee. The Universal Health Service would get a certain amount of money each year for each community in the state on per capita basis, plus some special needs funding to help under served and resourced communities come up to standard. But the decisions on how to provide services and who should provide them are made locally by the people who live in the communities and by the people who work in the system, by the providers.
More information:
National Health Service USA: http://nhsusa.wordpress.com
Physicians for a National Health Plan: www.pnhp.org
Health Care – Now: www.healthcare-now.org
Single Payer Action: www.singlepayeraction.org
Single Payer New York: http://singlepayernewyork.org

A Single-Payer, Community-Based Health Service


  • Universal, Comprehensive Coverage All medically necessary services, including rehabilitative, long-term, and home care, dental, optical, and mental healthcare, prescription drugs, and medical supplies; and preventive and public health measures.
  • Free at the point of delivery; No out-of-pocket payments Co-payments and deductibles are barriers to access, administratively unwieldy, and unnecessary for cost containment.
  • Free Choice of Providers Patients are free to seek care from any licensed health care provider.
  • A Single Public Payer Private insurance costs more, wasting of billions of dollars on useless paper pushing, marketing, excessive executive salaries, and profits. Single payer systems in other countries and our experience with Medicare and the Veterans Administration show public systems are more efficient.
  • Lower Costs A progressive taxes to finance health care will cost less in taxes for 95 percent of New Yorkers than they now pay in taxes plus insurance premium, co-pays, and deductibles. Overall health care expenses will be reduced due to administrative efficiencies.
  • Democratic Community and Worker Control  –  Not Corporate Dictates The public has an absolute right to democratically set overall health policies and priorities, but medical decisions must be made by patients and providers rather than dictated from afar. Market mechanisms principally empower employers and insurance bureaucrats pursuing narrow financial interests. Local health boards elected by the public and by health workers will administer the local health service and elect a regional and state boards to administer the regional and statewide programs.
  • Global Operating Budgets with Separate Allocation of Capital Funds  Billing on a per-patient fee-for-service basis creates unnecessary administrative complexity and expense. Each hospital, clinic, and care facility will operate under a global operating budget. A budget separate from operating expenses will be allowed for capital improvements. With doctors on salary instead of the income-maximizing fee-for-service piece-work system, budgeting can redress a number of problems in our present health care system, including the shortage of primary care doctors, the bias toward acute curative care over preventive care, and the inequitable geographic and class-based distribution of health resources. 
  • Ban on For-Profit Health Care Providers Profit seeking inevitably distorts care and diverts resources from patients to investors 
  • Just Transition for All Health Care and Insurance Workers A single-payer health program would eliminate the jobs of tens of thousands of people who currently perform billing, advertising, eligibility determination, and other superfluous tasks. These workers will be guaranteed income, retraining, and placement in meaningful new jobs. Many of these workers will be needed to deliver health care in clinical settings instead of the determining eligibility for care in insurance offices. 


The federal health care reform enacted in March 2010 mandates the purchase of private health insurance by individuals who do not qualify for public health care programs. The federal reform will not control costs, increase access, or, most importantly, improve the people's health. 

The federal reform is built around a set of back room deals which the Obama administration made with big drug, insurance, and hospital corporations. These corporations have every incentive to increase profits by diverting resources from medical care. The federal health care reform only entrenched the enormously inefficient and ineffective health care system that is already in crisis. The crises of cost, access, and outcomes will only worsen in the years ahead if we do not create a non-profit health care system funded by a single public payer.

With reform at the federal level blocked for the time being, it is time to take the initiative at the state level. New York State should enact a single payer health care plan and seek a federal waiver from the new federal system. 

A single public plan will provide access to comprehensive health care services for every New Yorker while saving New Yorkers billions of dollars a year. The New York State Department of Health and Department of Insurance contracted with the Urban Institute to compare 4 options for health reform in the state, including single payer (“Public Health Insurance for All”). The results of the two-year study released in July 2009 showed that single payer was the only plan that would cover everyone and was the most effective plan at controlling costs. The report found that the savings from single payer would substantially increase over time. By 2019, the Urban Institute analysis showed that single payer would save $20 billion annually compared to the present system. Single payer would cost $28 billion less annually than an individual mandate plan like the federal reform enacted in March 2010. 

Even better than single-payer health insurance would be a single-payer health service. Single payer insurance with private delivery fails to decouple major drivers of health care inflation: the fee-for-service payment system and the profit maximizing of for-profit health care delivery. While single payer insurance would be an improvement over the costly system of mixed public and private programs we now have, without also bringing the delivery of health care under public control, public health insurance will simply guarantee private health care profits without effective cost controls.

A federally funded study administered by the California's state Health and Human Services Agency looked at nine health care reform options in California in 2002, including two single payer insurance models and a single payer health service model. The single payer models were the only ones that saved money while providing universal coverage, with the health service model scoring best overall on cost, public accountability, and quality of care.

In a community-based health service, salaried physicians and other health workers would provide care in publicly budgeted nonprofit group practices. It would be democratic and responsive, governed from the bottom up by community health boards elected by local residents (two-thirds of board members) and health workers (one-third of board members). A single-payer health service would cost even less than single-payer health insurance because it eliminates the other inflationary cost drivers: fees-for-service and profit-maximizing providers. Prospective budgets for community health boards on a per capita basis, in place retrospective fee-for-service reimbursements by third-party insurance, would enable the correction of other major health system problems: the shortage of primary care doctors, the bias toward acute curative care over preventive care, and the inequitable geographic and class-based distribution of health resources.

We need a Universal Health Service funded by progressive income taxes and payroll taxes (social insurance) and paying the salaries and operating budgets of health care providers and their practices to delivery all medically necessary services to every New York resident. Progressive taxes can fund a Universal Health Service at significantly less cost than what both families and businesses now pay in taxes, insurance premiums, and out-of-pocket expenses. This reform would also provide huge relief to county budgets by eliminating their health care costs, especially Medicaid.

The predatory economic dynamic of our profit-oriented health care system is cannibalizing the rest of the economy. Health care spending now accounts for 17 percent of GDP and has grown at three times the rate of inflation for the last decade. Since 1999, employment-based health insurance premiums have increased 120 percent, compared to cumulative inflation of 44 percent and cumulative wage growth of 29 percent during the same period. Administrative costs and profits account for 31 percent of spending in private health insurance sector, compared to the 3.6 percent overhead for Medicare.

The US spends twice as much per person on health care as any other country in the world, but ranks 37th in health care outcomes, according to the World Health Organization.

47 million people are now uninsured and tens of millions more are underinsured. 62 percent of personal bankruptcies are due to medical bills and 68 percent of these people had health insurance.

The health care system is not delivering the medical care it should and it is bankrupting our country. We need to make health care a public service, not a profit-maximizing business. We need fundamental reform of both the payment system and the delivery system.

On the payment side, we need a single public payer through a Universal Health Service. The savings from administrative efficiencies would save enough to cover every New York resident with a comprehensive set of benefits covering all medically necessary services, including:

Primary care

Inpatient care

Outpatient care

Emergency care

Prescription drugs

Durable medical equipment

Long term care

Mental health services

Dentistry· Eye care

Chiropractic

Substance abuse treatment

Patients would have their choice of physicians, providers, hospitals, clinics, and practices. Patients would never pay co-pays or deductibles. The Universal Health Service would pay health care providers' salaries and operating budgets. The savings from reduced administration, bulk purchasing, and coordination among providers will allow coverage for all New Yorkers.


On the delivery side, we need to replace the fee-for-service system with salaried staff. Ninety-five percent of health care workers are already on salary. But the piecework system of fee-for-service builds in incentives for providers to maximize patients and procedures in order to maximize income under any system, single payer or multi payer, non-profit or especially for-profit. Without replacing fee-for-service with salaries, we will not contain costs in the long run. That is why we need a Universal Health Service (not just universal health insurance) where physicians and other staff work for a salary and not fees-for-service where specialties and volume bring in the most income at the expense of primary care and time for quality communication with patients.

The Universal Health Service would do more than simple provide universal "coverage," an insurance term meaning simply that health care costs would be "covered" for every U.S. resident.  It goes beyond this by ensuring that not only that health services would be paid for, but also that they would be available where and when users need them. Through funding of community and regional health services in all parts of the state, on a per capita basis, it would ensure that services were available to every resident.

Salaried physicians and other staff would work in non-profit, multi-specialty group practices.  The Universal Health Service would only fund services provided by publicly owned salaried group practices, on the model of the Veterans Administration in the US and public health services in the UK, Denmark, Cuba, and Costa Rica, or by non-profit organizations with salaried staff like the Group Health Cooperative in Seattle and the Mayo Clinic in Minnesota.

A decentralized federation of community health boards (one of each 25,000 or so people) elected by health care consumers and workers would govern the Universal Health Service. The community boards would send representatives to regional (metropolitan) and state boards where regional and state budgets and policies would be developed. This structure provides a community-based system -- controlled from the bottom up by those who use the system and those who work in it. The system has a budget, not an open-ended fee-for-service guarantee. The Universal Health Service would get a certain amount of money each year for each community in the state on per capita basis, plus some special needs funding to help under served and resourced communities come up to standard. But the decisions on how to provide services and who should provide them are made locally by the people who live in the communities and by the people who work in the system, by the providers.


More information:


National Health Service USA

Physicians for a National Health Plan

Health Care – Now

Single Payer Action

Single Payer New York

Additional information