Universal Health Care is the best!! Some Reflections


Universal health care?

Why can’t Americans insist that the United States should finally and profoundly have a national single payer health care program that would be for everyone? We have it with Medicare for the elders, we have a similar health care program for the veterans, so why not have a similar program for everyone in America regardless of income? If Trump wants to make America great, I find it hard to think of a better way to do this than through the implementation of a single payer universal health care system for all Americans.

In the 1970s I lived in Singapore and can certainly attest to its excellent healthcare system.  I also lived in Australia in the 1960s and 1970s and was also impressed with its national healthcare program. My Canadian relatives will not stay long out of Canada because of Canada’s universal healthcare system.

My son was born in Australia and there were automatic/established programs available after his birth to make sure he stayed healthy. “Good health” was a priority for the Australians under its national health care program so that, as much as possible, there would be no or fewer problems in the future. I admit I was surprised at this. You felt “cared” for and were “cared” for. All this is yet another way to prevent health problems in the future. It is yet another savings in terms of national health because fewer people become sick if, on a consistent basis, there is the infrastructure in place to both serve people and educate them about life saving health care strategies and healthy diets. You immediately know that you are not alone but part of a collective that cares for you and everyone else as well.

While organized differently, Singapore, Australia and Canada all have national health care programs. Friends of mine who were formerly American citizens, and who had moved to Australia in the 1960s, visited the United States in the 1990s.  While in the states one of them got sick and was in the hospital briefly, and then was handed a bill for $50,000. They immediately high-tailed it back to Australia and it’s universal health care system where you don’t go bankrupt if you get sick.

In a National Single Payer Health Care Program you save money because it is in the interest of the government to have “healthy” citizens so that the government can, in fact, save money. The government is not a private “capitalist” entity so its interest is not profit driven as is true in a privatized/capitalist driven programs. In the publicly funded health care system, programs are generally established to help people and their families stay healthy throughout their lives through diet, appropriate inoculations, periodic visits with health professionals etc. As mentioned, this saves the government money in the long run. Everybody wins under the circumstances and that’s a good thing.
According to the World Health Organization out of all the countries mentioned above (U.S., Australia, Singapore, Canada) and including the United Kingdom as well, that I refer to below, the United States has the lowest life expectancy and the highest health expenditures per GDP. I need to say also that the U.S. has the largest population. Below are some statistics:
The best of them was Singapore with a population of 5,604,000; m/f life expectancy 80/86 (2015); with total expenditure on health as % of GDP being 4.9 (2014).
Australia comes in a close second with a population of 23,969,000 (2015); male/female (m/f) life expectancy 81/85 (2015); with total expenditure on health as % of GDP being 9.4 (2014).
Canada comes in third with a population of 35,940,000 (2015); m/f life expectancy 80/84 (2015); with total expenditure on health as % of GDP being 10.4 (2014).
The United Kingdom comes in fourth with a population of 64,716,000 (2015); m/f life expectancy 79/83 (2015); with total expenditure on health as % of GDP being 9.1 (2014).
The U.S. had the worst statistics, yet it also has the largest population of them all – 321,774,000 (2015 ) – but the U.S. life expectancy for males and females (m/f) was 77/82 (2015); with total expenditure on health as % of GDP being 17% (2014).

Privatized Health Care? It is comparable to the “Military Industrial Complex” and the “Prison Industrial Complex” and is called the “Health Care Corporatized Complex”

It is thought that the reason American health care has exceptionally low ratings overall is because it is privatized. Human beings become commodified in a privatized health system, which is comparable to prisoners who become commodified in a privatized prison system. The more patients or prisoners you have the more money you make.  In a privatized system human beings, as patients, are essentially a “product” for someone else’s gain. This is a qualitative difference. Rather than human beings simply and profoundly seeking health care and having those who treat us as caring individuals or caring for the other, we as patients are more often used instead as part of a vicious cycle to enhance the income of, for example, a CEO of an insurance company or pharmaceutical company.

I frankly think this privatized concept and practice is decadent and should be rejected by Americans.

It was Eisenhower who warned us of the “military industrial complex”. A privatized military system is supported by the government subsidies, which is what we have in America. Whenever there is a conflict anywhere in the world, I am convinced the American military contractor CEOs, or let’s say those at Boeing, for example, open a bottle of champagne in their board rooms because they know they can get more money from the U.S. government and develop and sell more weapons. They are a capitalist company. They exist to make profits and they these profits it through war and conflicts rather than through peace. A peaceful world is not their priority.

So too with the Prison Industrial Complex. The more crime in America the more inmates they imprison and the more subsidies they receive. Is a crime-infested America their desire? Probably so, as it’s how they make their money.

So, too, with a privatized health care system. As Eisenhower warned us about the “Military Industrial Complex”, we should also be warned about the “Health Care Corporatized Complex,” which is also subsidized by the U.S. government at our expense. Is an unhealthy America in their interest? I am not sure, but an unhealthy America is how they make their money. We should all be circumspect!

Researching Medical Students, Physician Income, and Ted Kennedy’s “Medicare for All”

In the 1970s, I was engaged in research for Emory University in Atlanta and interviewed all the freshman medical students at Emory as well as a sampling of the freshman medical students at the University of Georgia.

At the time I did this research there were significant debates in Congress and around the country about possibly implementing a “Universal Health Care System” in the United States. Senator Ted Kennedy was a huge supporter of the program. Kennedy wanted “Medicare” for all. Unfortunately, this did not become a reality. Nevertheless, virtually all the students I talked with thought that by the time they finished medical school they would be working under a universal health care system. Here is some compelling information about Kennedy’s Bill – the official summary:

Medicare for All Act – Amends the Social Security Act to add a new title XXII (Medicare for All) under which: (1) each eligible individual is entitled to benefits which include the full range and scope of benefits available under the original fee-for-service program under parts A (Hospital Insurance) and B (Supplementary Medical Insurance) of title XVIII (Medicare), with parity in coverage of mental health benefits, subject to appropriate cost sharing; (2) each enrollee is free to choose his or her own doctor and private health plan; and (3) benefits are not less than the benefits offered to Members of Congress and Federal employees under FEHBP (Federal Employees Health Benefits Program).

Establishes the Medicare for All Trust Fund.

Amends the Internal Revenue Code to impose: (1) on the income of every individual a tax equal to 1.7% of wages received; (2) on every employer an excise tax equal to 7% of the wages paid to each employee; and (3) on the self-employment income of every individual, a tax equal to the applicable percentage of the self-employment income for such taxable year. (Daily Kos)

I also found, when studying the subject of universal health care, that in Britain, for example, under its universal health care system, the British physicians were largely considered superior to those we have in the United States. The reason, I was told, is because British physicians go into medicine not for financial gain but because they are interested in assisting and caring for people. Their motivations were, then, significantly and qualitatively different.

I know there are many compassionate and/or caring physicians in America as well because I’ve talked with them and have been treated by them, but what I found when doing my research of medical students in the 1970s was not encouraging. I assumed my findings had to do with young students living in a “market driven” economy rather than one that is primarily concerned about the humanity and the well being of the other.

I found in my research that many of the young medical students I interviewed seemed more interested in the money they could make from medicine than in a sentiment of concern for the other. I naively thought, when starting this research, that their sentiments would not be so crass. In fact, many of them had parents who were in medicine, who made a lot of money in their medical practice, and these students obviously wanted the same.

All that being said, physicians virtually anywhere in the world make a significant amount of money whether in the market driven or national health care system. So it is generally other entities within the market driven privatized health care system that jack up the costs, like insurance and big pharmaceutical companies. Nevertheless, below is a chart about the world’s physician incomes from 2008, with US physicians making the most compared to all other countries, and with American orthopedic surgeons making the most altogether. In a privatized system, the physicians have other financial concerns as well – such as insurance, infrastructure costs etc. – that would not be as predominant a need in a publicly run and controlled health care system.

Corporations Raking in the Money in a Privatized Health Care System

Further, as mentioned, in a privatized health care system, in addition to physicians, American corporations and their CEO’s are making huge profits. As Consumer Affairs notes: “Health insurance industry rakes in billions while blaming Obamacare for losses: Major insurance companies are enjoying record profits but claim they are losing money under the Affordable Care Act.”

UnitedHealth is but one example:

Consider UnitedHealth, the nation’s largest health insurer that is leaving the marketplace next year. UnitedHealth claims that Obamacare has reduced its 2016 earnings by $850 million. While they might have $850 million less than they wanted, UntedHealth’s profits are still soaring.

In fact, UnitedHealth announced record-breaking profits in 2015, followed by an even better year this year. In July 2016, UnitedHealth celebrated revenues that quarter totalling $46.5 billion, an increase of $10 billion since the same time last year.  And company filings show that UnitedHealth’s CEO Stephen J. Hemsley made over $20 million in 2015. To be fair, that is a pay cut. The previous year, in 2014, Hemsley took home $66 million in compensation. (Consumer Affairs)


The “sweaty little hand of corporate greed?” It should have no role in controlling our health care. Privatized? To me, there are a few areas in our life that are far too important to be controlled by corporate America and they are, for example, health care, education, prisons, military and agriculture. I am sure there are more!

Regardless of what Trump and his buddies come up with, which will likely be an on-going privatized system, it appears that we should all go back to the drawing board and develop a health care plan that would be good for all of us.

Let’s have, as Ted Kennedy and others recommended, a Medicare System for us all!


Regarding a “National Health Care” system I want to also share below the March 9, 2017 open letter to Donald Trump from the Physicians for a National Health Program (PNHP).

PNHP’s open letter to President Trump

An Open Letter To Trump:
The GOP Health Plan Won’t Work,
Replace ACA With Single Payer



The Huffington Post, March 9, 2017

Dear Mr. President,

You vowed to replace the Patient Protection and Affordable Care Act (ACA) with something great that would provide Americans with universal coverage and lower deductibles and copayments. As leaders of Physicians for a National Health Program (PNHP), a nonpartisan organization of 20,000 physicians and medical students, and as a business leader who desires fundamental health reform, we request an opportunity to meet with you to explain why single-payer, Medicare for all, is a great solution that will meet your stated goals.

Health care reform is urgently needed. Seven years after the passage of the ACA, 26 million Americans remain uninsured, tens of millions more are underinsured, and health care costs – already twice as high as the average of other wealthy nations – continue to rise. In a recent survey, Americans were more likely to report financial barriers to health care than citizens of any of the 11 other nations surveyed. One-third of Americans, including 43 percent of low-income persons, went without health care due to cost last year.

Unfortunately, “The American Health Care Act” (AHCA) would be a big step in the wrong direction. The bill would shrink Medicaid benefits for millions of poor and low-income families. It would sharply reduce the value of government subsidies, leaving millions of near poor and middle income Americans unable to afford coverage, and shifting millions of others to the kind of bare bones plans that you have decried. Meanwhile, it would give hundreds of billions of dollars of tax breaks to the wealthiest 2 percent of Americans, and reward insurance firms that pay outrageously high executive salaries.

In sum, this legislation will degrade already inadequate coverage, increasing financial barriers to care and endangering tens of thousands of lives, merely to reduce taxes on rich individuals and corporations.

The working people of America are looking to you for something better.

In contrast, a single-payer system, essentially an expanded and upgraded version of traditional Medicare, could meet your stated goals of more coverage, better benefits and lower costs. Such reform would drastically cut insurance overhead and the paperwork insurers inflict on doctors and hospitals, saving more than $500 billion annually. Those savings would cover the cost of universal, first-dollar coverage – including dental services and long-term care – upgrading coverage for the vast majority of Americans.

And a single-payer reform would allow the U.S. to use proven-effective tools to control costs. Instead of disrupting the delivery of care by shoehorning every doctor and hospital into a gigantic corporation, it would support practices and hospitals of all sizes with negotiated fees and global budgets. Negotiating prices with drug firms as other countries do would save another $150 billion annually. Controlling costs is the only way to make our health care system sustainable for future generations.

Single payer would lift the burden of health benefit costs from employers, making U.S. business more competitive. Richard Master, a business owner in Pennsylvania, produced the film “Fix It” to explain the benefits of single payer to business. Adopting a single-payer system would help keep jobs in the U.S.

Legislation for “improved Medicare for all,” H.R. 676, was introduced in the Congress last month by Rep. John Conyers. Polls have shown that 58 percent of Americans favor replacing the ACA with a single-payer system, as do 59 percent of physicians, 81 percent of Democrats, and a rapidly growing share of Republicans.

Single payer has proven effective in countries around the world, as evidenced by experience in Canada and Scotland, which spend far less than we do, cover everyone, and provide care free at the point of delivery. Tommy Douglas, the founder of Canada’s system, is ranked the most popular figure in that nation’s history, and Sen. Bernie Sanders attracted a huge following with his support for single payer, Medicare for all in his run for the Democratic primary.

PNHP has, from the outset, been strongly critical of the ACA’s failure to solve our nation’s health care crisis. The AHCA would divert us even further from the goal of solving that crisis and tarnish your legacy. Single-payer reform is the only solution.


Steffie Woolhandler, M.D., M.P.H., Co-founder PNHP

David Himmelstein, M.D., Co-founder, PNHP
Carol Paris, M.D., President, PNHP
Don McCanne, M.D., Senior Health Policy Fellow, PNHP
Adam Gaffney, M.D., Board member, PNHP
Janine Petito, Medical student board member, PNHP
Richard Master, Chairman & CEO, MCS Industries, Inc.

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