PNHP Research: The Case for a National Health Program

Over the past two decades, PNHP research has influenced health policy and focused debate on the need for fundamental health care reform.

1. Administrative costs consume 31 percent of US health spending, most of it unnecessary.
1. Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003.

2. Medical bills contribute to half of all personal bankruptcies. Three-fourths of those bankrupted had health insurance at the time they got sick or injured.
1. “Illness and Injury as Contributors to Bankruptcy,” Himmelstein et al, Health Affairs Web Exclusive, February 2, 2005.
2. “Medical Bankruptcy in the United States, 2007: Results of a National Study,” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009), Am J Med, 122, 741-746.
3. “Medical Bankruptcy Fact Sheet,” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009).
4. “Medical Bankruptcy Q&A,” Himmelstein, D.U., Thorne, D., Warren, E., Woolhandler, S. (2009).

3. Taxes already pay for more than 60 percent of US health spending. Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it.
1. Woolhandler, et al. “Paying for National Health Insurance — And Not Getting It,” Health Affairs 21(4); July/Aug. 2002.

4. Despite spending far less per capita for health care, Canadians are healthier and have better measures of access to health care than Americans.
1. Lasser et al. “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey,” American Journal of Public Health; July 2006, Vol 96, No. 7.

5. Business pays less than 20 percent of our nation’s health bill. It is a misnomer that our health system is “privately financed” (60 percent is paid by taxes and the remaining 20 percent is out-of-pocket payments).
1. Carrasquillo et al. “A Reappraisal of Private Employers’ Role in Providing Health Insurance,” NEJM 340:109-114; January 14, 1999.

6. For-profit, investor-owned hospitals1-4, HMOs,5 nursing homes6,7 and home health care agencies8 have higher costs and score lower on most measures of quality than their non-profit counterparts.
1. Himmelstein, D and Woolhandler, S “The high costs of for-profit care,” Commentary, Can. Med. Assoc. J., June 8, 2004
2. Devereaux, PJ “Payments at For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J., Jun 2004; 170
3. Devereaux, PJ “Mortality Rates of For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J, May 2002; 166
4. Himmelstein, et al “Costs of Care and Admin. At For-Profit and Other Hospitals in the U.S.” NEJM 336, 1997
5. Himmelstein, et al “Quality of Care at Investor-Owned vs. Not-for-Profit HMOs” JAMA 282(2); July 14, 1999
6. Harrington et al “Does Investor Ownership of Nursing Homes Compromise the Quality of Care?” American Journal of Public Health; Vol 91, No. 9, September 2001
7. Comondore, et al “Quality of care in for-profit and not-for-profit nursing homes: systematic review and meta-analysis,” BMJ 2009;339:b2732-b2732
8. Cabin W et al “For-Profit Medicare Home Health Agencies’ Costs Appear Higher And Quality Lower When Compared To Nonprofit Agencies,”Health Affairs, August 2014

7. Immigrants1 and emergency department visits2 by the uninsured are not the cause of high and rising health care costs. Immigrants also subsidize Medicare’s trust fund.3
1. Mohanty et al. “Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis,” American Journal of Public Health; Vol 95, No. 8, August 2005
2. Tyrance et al. “US Emergency Department Costs: No Emergency,” American Journal of Public Health; Vol 86, No. 11, November 1996
3. Zallman et al, “Immigrants contributed an estimated $115.2 billion more to the Medicare Trust Fund than they took out in 2002-09,” Health Affairs, June 2013

8. 45,000 annual deaths are associated with lack of health insurance1. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002. The uninsured do not receive all the medical care they need — one-third of uninsured adults have chronic illness and don’t receive needed care2. Those most in need of preventive services are least likely to receive them.
1. Wilper, et al “Health Insurance and Mortality in U.S. Adults,” American Journal of Public Health; Vol. 99, Issue 12, Dec 2009
2. Wilper, et al “A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults” Ann Intern Med, Aug 2008; 149: 170 – 176.

9. The US could save enough on administrative costs1 (more than $350 billion annually) with a single-payer system2 to cover all of the uninsured.
1. Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept 21, 2003
2. “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance,” JAMA 290(6): Aug 30, 2003

10. Competition among investor-owned, for-profit entities has raised costs, reduced quality in the US
1. Himmelstein DU, Woolhandler S. “Competition in a publicly funded healthcare system.” BMJ 2007;335:1126-1129 (1 December), doi:10.1136/bmj.39400.549502.94
2. Hellander I, Himmelstein DU, Woolhandler S. “Medicare overpayments to private plans, 1985-2012: Shifting seniors to private plans has already cost Medicare US$282.6 billion.” International Journal of Health Services 2013;43(2):305–319. doi:

11. The Canadian single payer healthcare system produces better health outcomes1,2 with substantially lower administrative costs3,4 than the United States.
1. Guyatt GH, et al. “A systematic review of studies comparing health outcomes in Canada and the United States.” Open Medicine (2007); 1(1): E27-35.
2. Lasser KE, Himmelstein DU, Woolhandler S. “Access to Care, Health Status, and Health Disparities in the United States and Canada: Results of a Cross-National Population-Based Survey.” American Journal of Public Health (July 2006); 96(7): 1300-1307.
3. Himmelstein DU, Lewontin JP, Woolhandler S. “Who administers? Who cares? Medical administrative and clinical employment in the United States and Canada.” American Journal of Public Health. (1 Feb. 2006); 86(2):172-178.
4. Woolhandler S, Campbell T, Himmelstein DU. “Cost of Health Care Administration in the United States and Canada.” New England Journal of Medicine. (21 August 2003); 349(8).

12. Computerized medical records1-3 and chronic disease management4 do not save money. The only way to slash administrative overhead5 and improve quality6,7 is with a single payer system.
1. Woolhandler, et al. “Hope And Hype: Predicting The Impact Of Electronic Medical Records,” Health Affairs, September/October 2005; 24(5): 1121-1123.
2. Himmelstein, et al “Hospital computing and the costs and quality of care: a national study,” Am J Med, Vol 123, Issue 1, Pages 40-46, Jan 2010
3. McCormick, D, Bor, DH, Woolhandler, S, Himmelstein, DU, “Giving Office-Based Physicians Electronic Access To Patients’ Prior Imaging And Lab Results Did Not Deter Ordering Of Tests,” Health Affairs, March 2012, 31(3): 488-496.
4. Geyman, J “Disease Management: Panacea, Another False Hope, or Something in Between?,” Ann Fam Med 2007;5:257-260. DOI: 10.1370/afm.649.
5. Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003
6. Schiff, et al “A Better Quality Alternative” JAMA, 272(10); Sept. 12 1994
7. Schiff, et al “You Can’t Leap a Chasm in Two Jumps,” Public Health Reports 116, Sept / Oct 2001

13. Alternative proposals for “universal coverage” do not work. State health reforms over the past two decades have failed to reduce the number of uninsured1.
1. Woolhandler, et al “State Health Reform Flatlines,” International Journal of Health Services, Volume 38, Number 3, Pages 585-592, 2008

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