Universal Health Care

Author: Ralph Nader

Topic: Issues

The state of health care in the United States is a disgrace to our democracy. The United States spends more per person on health care than any other country in the world, but the World Health Organization ranked the U.S. 37th in the overall quality of health care that it provides. We are the only industrialized country that lacks universal health care. More than 42 million Americans have no health insurance.

Access to health care is distributed unequally among rich and poor, and also among the races. Among whites, 11% lack health insurance, already a shocking number. But 21% of African-Americans, 21% of Asians and 33% of Hispanics lack health insurance. This translates directly into higher infant mortality and lower life expectancy. Young people aged 18-24 have a higher uninsured rate than any other age group, with 29% uninsured.

Health care should be provided by a national health insurance program providing comprehensive benefits to all Americans throughout their lives, and funded directly by the federal government (known as a "single-payer" system). Under the current system, hundreds of billions of dollars a year go into insurance company overhead, unnecessary and fraudulent billing and administrative costs for health-care providers, and huge profits and high salaries at large HMOs and other health-care companies. Studies show that savings from a single-payer system would be more than enough to allow us to provide universal coverage for the same amount that we are now paying for inadequate health care.

In addition to leaving broad segments of the population uninsured or under-insured, the U.S. health care system has many other important faults that could be remedied by a system of universal coverage. These include serious gaps in coverage for: prescription drugs and medical supplies; dental, vision and hearing care; long-term care; mental health care; preventive care for children; and treatment for substance abuse.

We find persuasive a plan based on the "Physicians' Proposal" for a national health program published by Physicians for a National Health Program in the New England Journal of Medicine in 1989, and their proposal for a national long-term care program published in the Journal of the American Medical Association in 1991. Under this plan:

• Everyone would be included in a single, comprehensive public plan covering all medically necessary services, including acute, rehabilitative and long-term care, mental-health services, dental care, prescription drugs and medical supplies.
• Everyone would have access to personalized care with a local primary care physician, and free choice of doctors at all times.
• Health care providers would still be in the private sector, and the health plan would provide for different payment schemes for health-care providers, to minimize the disruption of the existing system. The payment schemes would be designed to prevent profit motives from influencing physicians, so there would be no incentives to recommend too much or too little care.
• A transition fund would be established for those health-care administrators and insurance-company employees whose jobs would be eliminated due to the simplicity of the single-payer system.

Although we could provide universal, single-payer health insurance for the same amount that we spend on health care now, we would need funding to replace the portion now paid for by employers and individuals. We would do this through several mechanisms:

• A small payroll tax (A small tax on stock and bond transactions (1/4 of 1% of transaction value for both the buyer and the seller). For long-term investors, this tax would be negligible. It would have the additional effect of reducing short-term speculation and thus the volatility of the markets.
• An additional income tax on the wealthiest 5% of Americans. Other Americans would pay no additional taxes, and would be free from health-insurance premiums and from out-of-pocket spending for medically necessary services.
• Closing corporate tax loopholes to ensure that corporations pay their fair share of taxes.

Providing universal health care can only be accomplished through a single-payer system: no country has ever achieved universal coverage with private health insurance. The time to act is now.