Single-Payer Reform: The Only Way to Fulfill the President's Pledge of More Coverage, Better Benefits, and Lower Costs
Authors: Steffie Woolhandler, David U. Himmelstein
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions18 April 2017Single-Payer Reform: The Only Way to Fulfill the President's Pledge of More Coverage, Better Benefits, and Lower CostsCorrection(s) for this article:CorrectionsJun 2019Correction: Single-Payer ReformFREESteffie Woolhandler, MD, MPH and David U. Himmelstein, MDSteffie Woolhandler, MD, MPHFrom The City University of New York at Hunter College, New York, New York. and David U. Himmelstein, MDFrom The City University of New York at Hunter College, New York, New York.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0302 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail This article has been corrected. The original version (PDF) is appended to this article as a Supplement.President Donald Trump and congressional Republicans have vowed to repeal and replace the Patient Protection and Affordable Care Act (ACA). Repealing it is relatively easy. Replacing it with "something great" is much trickier. The president has promised universal coverage and reduced deductibles and copayments, all within tight budgetary constraints. That is a tall order and unlikely to be filled by proposals that Republicans have offered thus far.Speaker of the House Paul Ryan's blueprint (1) would rebrand the ACA's premium subsidies as "tax ...References1. A Better Way. A better way: our vision for a confident America. 22 June 2016. Accessed at https://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf on 1 February 2017. Google Scholar2. The Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. 2016 annual report of the Boards of Trustees, Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. 22 June 2016. Accessed at www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2016.pdf on 2 February 2017. Google Scholar3. Woolhandler S, Campbell T, Himmelstein DU. Costs of health care administration in the United States and Canada. N Engl J Med. 2003;349:768-75. [PMID: 12930930] CrossrefMedlineGoogle Scholar4. Himmelstein DU, Jun M, Busse R, Chevreul K, Geissler A, Jeurissen P, et al. A comparison of hospital administrative costs in eight nations: US costs exceed all others by far. Health Aff (Millwood). 2014;33:1586-94. [PMID: 25201663] doi:10.1377/hlthaff.2013.1327 CrossrefMedlineGoogle Scholar5. Pozen A, Cutler DM. Medical spending differences in the United States and Canada: the role of prices, procedures, and administrative expenses. Inquiry. 2010;47:124-34. [PMID: 20812461] CrossrefMedlineGoogle Scholar6. Baicker K, Taubman SL, Allen HL, Bernstein M, Gruber JH, Newhouse JP, et al; Oregon Health Study Group. The Oregon experiment—effects of Medicaid on clinical outcomes. N Engl J Med. 2013;368:1713-22. [PMID: 23635051] doi:10.1056/NEJMsa1212321 CrossrefMedlineGoogle Scholar7. Enterline PE, Salter V, McDonald AD, McDonald JC. The distribution of medical services before and after "free" medical care—the Quebec experience. N Engl J Med. 1973;289:1174-8. [PMID: 4754965] CrossrefMedlineGoogle Scholar8. Wilder CS. Volume of physician visits. United States—July 1966-June 1967. Vital Health Stat 10. 1968;10:1-60. [PMID: 5303847] MedlineGoogle Scholar9. Physicians for a National Health Program. How much would a single payer cost? A summary of studies compiled by Ida Hellander, MD. 2016. Accessed at www.pnhp.org/facts/single-payer-system-cost on 2 February 2017. Google Scholar10. Newport F. Majority in U.S. support idea of fed-funded healthcare system. Gallup. 16 May 2016. Accessed at www.gallup.com/poll/191504/majority-support-idea-fed-funded-healthcare-system.aspx on 2 February 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: From The City University of New York at Hunter College, New York, New York.Disclaimer: Drs. Woolhandler and Himmelstein served as unpaid advisors to Senator Bernie Sanders' presidential campaign. They cofounded and remain active in Physicians for a National Health Program, an organization that advocates for single-payer national health insurance. They have received no financial compensation from that organization and have no financial conflicts of interest regarding this commentary.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0302.Corresponding Author: Steffie Woolhandler, MD, MPH, 255 West 90th Street, New York, NY 10024; e-mail, [email protected]cuny.edu.Current Author Addresses: Drs. Woolhandler and Himmelstein: 255 West 90th Street, New York, NY 10024.Author Contributions: Analysis and interpretation of the data: S. Woolhandler, D.U. Himmelstein.Drafting of the article: S. Woolhandler, D.U. Himmelstein.Final approval of the article: S. Woolhandler, D.U. Himmelstein.Collection and assembly of data: S. Woolhandler, D.U. Himmelstein.This article was published at Annals.org on 21 February 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSingle-Payer Reform Gilead I. Lancaster and Joseph P. Drozda Jr. Single-Payer Reform Steffie Woolhandler and David U. Himmelstein Correction: Single-Payer Reform Metrics Cited byCost of Medicare for All: Review of the EstimatesAI applications in the business and administration of health careThe effect of Medicare for All on rural hospitals – Authors' replyIt's the Politics, Stupid: Why More "Skin in the Game" Will Not Help Control US Healthcare SpendingImproving the prognosis of health care in the USAEnvisioning a Better U.S. Health Care System for All: Coverage and Cost of CareRyan Crowley, BSJ, Hilary Daniel, BS, Thomas G. Cooney, MD, and Lee S. 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Drozda Jr., MDSingle-Payer ReformDavid Silverman, MDPopulation health and medicine: Policy and financial drivers 18 April 2017Volume 166, Issue 8Page: 587-588KeywordsDisclosureDrugsHealth careHealth economicsHealth insuranceMedicarePatient Protection and Affordable Care ActPhysiciansPublic policyTaxes ePublished: 21 February 2017 Issue Published: 18 April 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...