We can thank Bernie Sanders' presidential campaign for putting single-payer national health insurance (NHI) on the front burner of today's national political discussion. This is long overdue and especially timely as the two parties debate alternatives for future U. S. health care. It appears that political feasibility for NHI may finally be approaching a time of acceptance, if our democracy can prevail over oligarchy and plutocracy.

The 20,000 physician-strong Physicians for a National Health Program (PNHP) has released today a Physicians' Proposal for Single-Payer Health Care Reform, updated from its 2003 proposal (1), with an accompanying editorial. (2) It describes how traditional Medicare can be expanded to cover our entire population for necessary health care, provide comprehensive benefits to all Americans, give us free choice of physician and hospital, reduce waste and bureaucracy, and save money at the same time. This proposal by a non-partisan, not-for-profit national organization has been endorsed by more than 2,200 physician colleagues in all specialties. (3) More recently, it has been endorsed by an additional 560 physicians and medical students. (4) In its 2004 report, the Institute of Medicine (now the National Academy of Medicine) called for universal health care by 2010, listing single-payer NHI as one of the alternatives; none of the other alternatives could ever be expected to achieve universal coverage, as they remain part of the problem. (5)

This 2016 election season brings us three very different alternatives concerning future health care in this country: (1) continuation of the Affordable Care Act (ACA) with changes as necessary; (2) a Republican "plan" for health care; and (3) single-payer NHI. Despite some expansions of coverage, especially through Medicaid, the ACA has failed to make health care more affordable, has accelerated waste, bureaucracy and profiteering, and is unsustainable. Yet Hillary Clinton calls for expansion of the ACA to 100 percent coverage with no possible way of doing it by retaining some 1,300 private insurers. She also claims disingenuously that NHI will raise our taxes--without acknowledging that Gerald Friedman's classic 2013 study found that 95 percent of Americans will pay less for insurance premiums, deductibles, co-payments, actual care and out-of-pocket payments, and that only the wealthiest five percent would pay more. (6)

Although no concrete plan has yet been advanced by the GOP, we can expect that it will repeal the ACA, then "replace" it with long discredited reliance on free markets in health care, consumer directed health care, health savings accounts, selling insurance across state lines, and high-risk pools.

Neither the ACA nor GOP options will make health care more affordable or accessible. Single-payer NHI is the only alternative that will achieve universal coverage in an affordable and sustainable way. A strong case for it has been made elsewhere on economic, sociopolitical, and moral grounds. (7) It will meet conservatives' principles regardless of party affiliation, including efficiency, maximal choice, minimal waste, value, and everyone contributes in proportion to his or her income. (8) Long an iconic guru of free-market economics, Kenneth J Arrow, has recently acknowledged that "a single-payer system is better than any other system", as long as private practice is preserved (as it would be with NHI). (9)

We know that powerful forces are aligned against passage of NHI,

including private insurers, Big PhRMA, medical device makers, and other members of the medical-industrial complex. They are empowered further by their hundreds of lobbyists and corporate money in our post-Citizens United world. As Bernie Sanders has observed: "the Koch brothers, as the second-wealthiest family in America with $82 billion in wealth, advocate destruction of federal programs that are critical to the financial and personal health of middle-class Americans." (10)

Sorting through the three major financing alternatives for our health care will test whether or not we have a real democracy. Much of the corporate-owned media under-report the single-payer alternative, misinform the public, and perpetuate myths, such as we can't afford NHI, net spending would go up because of increased taxes, or the government would ration care. These myths and memes have been discussed in detail elsewhere (11). Solid, reliable updated information on NHI can be found on PNHP's website (www.pnhp.org).

Democracy can win, but we will need progressive leadership. It is encouraging that Bernie is leading in recent polls in a matchup against Donald Trump or any other Republican presidential nominee. With a large and growing grassroots support from across the country, Bernie should have considerable leverage on the Democratic platform, which hopefully can move Hillary to a progressive position on health care. Recall Hillary's words in 1994, speaking to a group at Lehman Brothers Health Corporation:

. . . if there is no health care reform this year, and if, for whatever reason, the Congress doesn't pass health care reform . . . I believe that by the year 2000 we will have a single-payer system . . . I don't even think it's a close call politically. I think that the momentum for a single-payer system will sweep the country . . . it will be such a huge popular issue . . . that even if it's not successful the first time, it will eventually be. (12)

Health care is too important to be gridlocked in polarized partisan camps. All Americans will win with NHI, including the business community, which will be relieved of its burden of paying growing costs of employer-sponsored health insurance. Time will tell whether or not the oligarchy wins again.

References:

1. The Working Group on Single-Payer Program Design. Beyond the Affordable Care Act: A Physicians' Proposal for Single-Payer Health Care Reform. Available a supplement online version of ref. 1 at http://www.ajph.org

2. Gaffney, A, Woolhandler, S, Angell, M, Himmelstein, DU. Editorial. Moving forward from the Affordable Care Act to a Single-Payer system. Am J Public Health, 106 (6): e1-e2, June 2016.



3. Carroll, AE, Ackermann, RT. Support for national health insurance among U. S. physicians: five years later. Ann Intern Med 1481: 566-567, 2008.

4. Woolhandler, S, Himmelstein, DU. Setting the record straight on Medicare for All: An open letter from 560 physicians and medical students. The Huffington Post, February 28, 2016.

5. Committee on the Consequences of Uninsurance. Institute of Medicine. Insuring America's Health: Principles and Recommendations. National Academies Press, Washington, D.C., 150-151, 2004.

6. Friedman, G. Funding H. R. 676: The Expanded and Improved Medicare for All Act. How We Can Afford a National Single-Payer Health Plan. Physicians for a National Health Program. Chicago, Il. July 31, 2013. Available at: htpp://www.pnhp.org/sites/default/files/Funding%20HR%20676_Friedman_final_7.31.13.pdf

7. Geyman, JP. The Human Face of ObamaCare: Promises vs. Reality and What Comes Next. Friday Harbor, WA. Copernicus Healthcare, 199-202, 2016.

8. Light, DW. A conservative call for universal access to health care. Penn J Bioethics 9 (4): 4-6, 2002.

9. Arrow, KE. As quoted by Pro-Market. The blog of the Stigler Center at the University of Chicago Booth School of Business, March 15, 2016.

10. Sanders, B. This is what oligarchy looks like. Bernie 2016, January 4, 2016.

11. Geyman, JP. Myths and memes as barriers to health care reform. In Geyman, JP. How Obamacare Is Unsustainable: Why We Need a Single-Payer Solution for All Americans. Friday Harbor, WA. Copernicus Healthcare, 2015, pp. 223-241.

12. Clinton, H. Speaking to a group at Lehman Brothers Health Corporation, June 15, 1994, as reported by Health Care for All-WA Newsletter, Winter 2015, p 9.

