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Dr. David Himmelstein & Dr. Sidney Wolfe
Daniel Goleman, photo by Robin Holland
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May 22, 2009

Health care reform is coming. Both Congress and President Obama have made it a top priority, and many expect a bill by the fall.

Now comes the tricky part — designing and funding a plan. President Obama has outlined broad goals, several competing plans have been introduced in the Congress, and the Republican party recently introduced its own plan.

>>Compare the current plans.

Whence Single-Payer?
But Dr. David Himmelstein and Dr. Sidney Wolfe tell Bill Moyers on the JOURNAL that President Obama isn't considering a popular plan — single-payer. In a recent town-hall meeting in New Mexico, President Obama said switching to single-payer would be too disruptive.

The term "single-payer" generally means a system in which rather than having private, for-profit insurance companies, the government runs one large non-profit insurance organization. That organization pays all the doctor, drug and hospital bills — it is the "single-payer" of all medical bills. In most single-payer plans, every American would be enrolled and would pay into the fund through taxes.

Advocates argue that a single-payer system would pay for itself, saving huge amounts of money in administrative costs. The U.S. currently pays a higher percentage of health dollars for administration than any other nation.

The U.S. also ranks highest in total cost of care, but according to a recent report by the Commonwealth Fund, ranks last among industrialized countries "in preventing deaths through use of timely and effective medical care." In a recent FRONTLINE report comparing the health care systems of five other capitalist democracies, "Sick Around the World," WASHINGTON POST reporter T.R. Reid notes that, "The World Health Organization says the U.S. health care system rates 37th in the world in terms of quality and fairness. All the other rich countries do better than we do, and yet they spend a heck of a lot less."

>>Watch "Sick Around the World" to see how five other countries provide health care.

>>Is "single payer" the way to go? Read more below and then weigh in on The Moyers Blog.

Dr. David Himmelstein
Dr. David Himmelstein is associate professor of medicine at Harvard Medical School and serves as the chief of the Division of Social and Community Medicine at Cambridge Hospital where he practices primary care internal medicine. He received his M.D. from Columbia University and completed internal medicine training at Highland Hospital/University of California San Francisco, and a fellowship in general internal medicine at Harvard.

Dr. Himmelstein was a founder of Physicians for a National Health Program and serves as co-director of the Center for National Health Program Studies at the Cambridge Hospital/Harvard Medical School. He co-edits PNHP's newsletter and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. Steffie Woolhandler.

Dr. Sidney Wolfe
Sidney Wolfe, MD is acting President of Public Citizen and director of its Health Research Group. In 1966 he began working at the National Institutes of Health where he did research on aspects of blood-clotting and on alcoholism. Dr. Wolfe met Ralph Nader in Washington, D.C. at a meeting of the American Patients Association, began advising Mr. Nader on health problems in America and helped in the recruitment of medical student volunteers who worked for Mr. Nader.

Since 1995 he has been an adjunct professor of Internal Medicine at the Case Western Reserve University School of Medicine. His medical degree is from Case Western University in Cleveland, Ohio and his internship and residency were in internal medicine. He is currently a member of the Society for General Internal Medicine. His awards include receiving the MacArthur Foundation Fellowship in 1990.

Published May 22, 2009.

Guest photos by Robin Holland

Related Media:
Medical practitionersCalifornia Nurses Association
The California Nurses Association advocates a single payer national health insurance system. (May 5, 2008)

Melody Petersen, photo by Robin Holland Melody Petersen
Melody Petersen talks with Bill Moyers about her new book OUR DAILY MEDS, and how drug companies market medication. (May 16, 2008)

Rachel CarsonFRONTLINE: "Sick Around the World"
FRONTLINE travels to five other wealthy capitalist democracies — Great Britain, Japan, Germany, Taiwan, and Switzerland — to find out how they provide health care to all of their citizens far a fraction of the cost of the U.S. system.

References and Reading:
Public Citizen Health Research Group
"Public Citizen is a national, nonprofit consumer advocacy organization founded in 1971 to represent consumer interests in Congress, the executive branch and the courts"

Physicians for a National Health Program
"Physicians for a National Health Program is a non-profit research and education organization of 16,000 physicians, medical students and health professionals who support single-payer national health insurance."

Side-by-side comparison the major health care reform proposals.
Assembled by The Henry J. Kaiser Family Foundation.

"Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2008"

Senate Finance Committee white paper on health care
White paper by Senator Max Baucus's committee discussed in the interview.

"Massachusetts Health Reform: The Myth of Uncontrollable Costs"
A report from the Massachusetts Taxpayers Foundation, May 2009.

"Obamacare to Come: Seven Bad Ideas for Health Care Reform"
By Michael D. Tanner, CATO INSTITUTE, May 21, 2009.

"The Moral-Hazard Myth"
By Malcolm Gladwell, THE NEW YORKER, August 29, 2005.

"TIMES TOPICS: Health Care Reform"

Also This Week:

Washington's abuzz about health care, but why isn't a single-payer plan an option on the table? Public Citizen's Dr. Sidney Wolfe and Physicians for a National Health Program's Dr. David Himmelstein on the political and logistical feasibility of health care reform.

Bill Moyers speaks with advocate Donna Smith about how our broken system is hurting ordinary Americans.

Explore the JOURNAL's veterans' issues, get resources for vets and their families and find out how to contribute an oral history of a veteran to the National Veteran's History Project.

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