Proposal of the Physicians' Working Group
for Single-Payer National Health Insurance
In 2003, the Physicians’ Working Group for Single-Payer National Health Insurance issued a detailed proposal that is summarized below. The document was composed by a distinguished group of physician leaders and was endorsed by about 8,000 physicians and medical students by the time it was published in JAMA.. The group estimated that its plan would save more than enough each year to cover the uninsured by eliminating the high overhead and profits of the private investor-owned insurance industry, reducing marketing expenses, and reducing the cost of processing burdensome paperwork. To access the full JAMA report, click here.
- Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right. Coverage should not be tied to employment. Private insurance firms’ past record disqualifies them from a central role in managing health care.
- The right to choose and change one’s physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.
- Pursuit of corporate profit and personal fortune have no place in caregiving and they create enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing, and useless or even harmful medical interventions must be shifted to needed care.
- The public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.
- Eligibility and coverage: A single public plan would cover every American for all medically necessary services, including long-term care, mental health and dental services, and prescription drugs and supplies. Unnecessary or ineffective services would be excluded from coverage. Private insurance duplicating the public coverage would be proscribed. Patient co-payments and deductibles would also be eliminated.
- Hospital payment: Each hospital would receive a monthly payment to cover operating expenses. The amount would be negotiated annually. Hospitals would not bill for noncovered services and could not use their operating budgets for expansion, profit, excessive executives’ incomes, marketing, or major capital purchases or leases. Major capital expenditures would come from the NHI fund and would be appropriated separately based on community needs. Investor-owned hospitals would be converted to nonprofit status and their owners compensated for past investment.
- Payment for physicians and outpatient care: Practitioners could choose from three payment options: (1) fee-for-service, (2) salaried practice in institutions receiving global budgets, or (3) salaried practice in group practices or HMOs receiving capitation payments. Investor-owned HMOs and group practices would be converted to nonprofit status.
- Long-term care: Americans of all ages would be covered for all necessary home and nursing home care. Persons unable to perform activities of daily living would be eligible for services. A local public agency in each community would determine eligibility, coordinate care, and contract with providers. For-profit nursing homes and home-care agencies would be converted to not-for-profit status. Individual long-term care providers would be paid on either a fee-for-service or salaried basis.
- Medications and supplies: The program would pay for all medically necessary prescription drugs and medical supplies, based on a national formulary eatablished by experts. The program would negotiate drug and equipment prices with manufacturers.
- Capital spending: The NHI budget would fund the construction of health facilities and the purchase of expensive equipment. Regional health planning boards would allocate these funds. These boards would also oversee privately funded projects that might increase future publicly supported operating costs.
This article was posted on August 7, 2009.