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Caring for the Uninsured and Underinsured |

Liberal Benefits, Conservative Spending: Title and subTitle BreakThe Physicians for a National Health Program Proposal FREE

Kevin Grumbach, MD; Thomas Bodenheimer, MD, MPH; David U. Himmelstein, MD; Steffie Woolhandler, MD, MPH
[+] Author Affiliations

Reprint requests to Physicians for a National Health Program, 1493 Cambridge St, Cambridge, MA 02139 (Dr Grumbach).


From Physicians for a National Health Program, Cambridge, Mass (Drs Grumbach, Bodenheimer, Himmelstein, and Woolhandler); the Institute for Health Policy Studies (Dr Grumbach) and the Department of Family and Community Medicine, University of California, San Francisco (Drs Grumbach and Bodenheimer); the Department of Medicine, the Cambridge (Mass) Hospital and Harvard Medical School (Drs Himmelstein and Woolhandler); and the Public Citizen Health Research Group, Washington, DC (Dr Himmelstein). Dr Grumbach is a Pew Health Policy Fellow.


JAMA. 1991;265(19):2549-2554. doi:10.1001/jama.1991.03460190127034
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The Physicians for a National Health Program proposes to cover all Americans under a single, comprehensive public insurance program without copayments or deductibles and with free choice of provider. Such a national health program could reap tens of billions of dollars in administrative savings in the initial years, enough to fund generous increases in health care services not only for the uninsured, but for the underinsured as well. We delineate a transitional national health program budget that would hold overall health spending at current levels while accommodating increases in hospital and physician utilization. Future national health program spending would be indexed to the growth in gross national product adjusted for demographic, epidemiologic, and technologic shifts. Financing for the national health program would transfer funds into the public program without disrupting the general pattern of current revenue sources. We suggest a funding package that would augment existing government health spending with earmarked health care taxes. Because these new taxes would replace employer-employee insurance premiums and substantial portions of current out-of-pocket expenditures, they would not increase health costs for the average American.

(JAMA. 1991;265:2549-2554)

REFERENCES

US Bipartisan Commission on Comprehensive Health Care. A Call for Action . Washington, DC: The Pepper Commission on Comprehensive Health Care; 1990;.
National Leadership Commission on Health Care. For the Health of a Nation . Ann Arbor, Mich: Health Administration Press; 1989;.
Health Access America . Chicago, Ill: American Medical Association; 1990;.
Kennedy E. Senate Bill S.768. November 20, 1989.
Woolhandler S, Himmelstein DU.  Resolving the cost/access conflict: the case for a national health program . J Gen Intern Med. 1989;;4:54-60.
Grumbach K.  National health insurance in America: can we practice with it? can we practice without it? West J Med. 1989;;151:210-216.
Himmelstein DU, Woolhandler S.  A national health program for the United States: a physicians' proposal . N Engl J Med. 1989;;320:102-108.
Woolhandler S, Himmelstein DU.  A national health program: a northern light at the end of the tunnel . JAMA. 1989;;262:2136-2137.
Health Care Financing Administration.  National health expenditures: 1986-2000 . Health Care Financing Rev . 1987;;8( (4) ):1-36.
Needleman J, Arnold J, Sheils J, Lewin LS. The Health Care Financing System and the Uninsured . Washington, DC: Lewin/ICF; 1990;.
Newhouse JP, Manning WG, Morris CN, et al.  Some interim results from a controlled trial of cost sharing in health insurance . N Engl J Med. 1981;;305:1501-1507.
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;;289:1174-1178.
McDonald AD, McDonald JC, Salter V, Enterline P.  Effects of Quebec Medicare on physician consultation for selected symptoms . N Engl J Med. 1974;;291:649-652.
Brook RH, Ware JE Jr, Rogers WH, et al.  Does free care improve adults' health? results from a randomized controlled trial . N Engl J Med. 1983;;309:1426-1434.
Eisenberg JM. Doctors' Decisions and the Cost of Medical Care . Ann Arbor, Mich: Health Administration Press; 1986;.
Wennberg J.  Outcomes research, cost containment, and the fear of health care rationing . N Engl J Med. 1990;;323:1202-1204.
Chassin MR, Kosecoff J, Park RE, et al.  Does inappropriate use explain geographic variations in the use of health care services? JAMA. 1987;;258:2533-2537.
Himmelstein D, Woolhandler S.  Cost without benefit: administrative waste in US health care . N Engl J Med. 1986;;314:441-445.
Aggregate Hospital Financial Data for California: Report Periods Ending June 30,1987—June 29, 1988 . Sacramento: California Health Facilities Commission; 1989;.
Gonzalez ML, Emmons DW. Socioeconomic Characteristics of Medical Practice . Chicago, Ill: American Medical Association; 1988;.
Iglehart J.  Canada's health system faces its problems . N Engl J Med. 1990;;322:562-568.
American Medical Association.  The administrative burden of health insurance on physicians . Socioeconomic Monitoring Survey Rep. 1989;;3:2-4.
National Health Expenditures . Ottawa, Ontario: Health and Welfare Canada; 1990;.
Grumbach K, Bodenheimer T.  Reins or fences? a physician's view of cost containment . Health Aff. 1990;;9( (4) ):120-126.
Last JM.  Controlling the smoking epidemic . Am J Prev Med. 1985;;1:1-3.
Wagstaff A, Van Doorslaer E, Paci P.  Equity in the finance and delivery of health care: some tentative cross-country comparisons . Oxford Rev Econ Policy. 1989;;5:89-112.
Levit KR, Freeland MS, Waldo DR.  National health care spending trends: 1988 . Health Aff. 1990;;9( (2) ):171-184.
Reinhardt UE.  Health insurance for the nation's poor . Health Aff. 1987;;6( (1) ):101-112.
Levit KR, Freeland MS, Waldo DR.  Health spending and ability to pay: business, individuals, and government . Health Care Financing Rev. 1989;;10( (3) ):1-11.
Pechman JA. Federal Tax Policy . Washington, DC: The Brookings Institution; 1987;.
Bergthold LA. Purchasing Power in Health . New Brunswick, NJ: Rutgers University Press; 1990;.
DiCarlo S, Gabel J.  Conventional health insurance: a decade later . Health Care Financing Rev. 1989;;10( (3) ):77-89.
Bureau of the Census. Statistical abstract of the United States 1990 . Washington, DC: US Dept of Commerce; 1990;.
Bureau of the Census. Quarterly Summary of Federal, State, and Local Tax Revenue, July-September 1989 . Washington, DC: US Dept of Commerce; 1990.
Congressional Budget Office. Reducing the Deficit: Spending and Revenue Options . Washington, DC: The Congress of the United States; 1990;.
Blendon RJ, Donelan K.  The public and the emerging debate over national health insurance . N Engl J Med. 1990;;323:208-212.
Aaron H, Schwartz WG.  Rationing health care: the choice before us . Science. 1990;;247:418-422.
 International comparisons of health care financing and delivery: data and perspectives . Health Care Financing Rev. 1989;; 10( (suppl) ):1-196.
Pfaff M.  Differences in health care spending across countries: statistical evidence . J Health Polit Policy Law . 1990;;15:1-24.
Evans RG, Lomas J, Barer ML, et al.  Controlling health expenditures: the Canadian reality . N Engl J Med. 1989;;320:571-577.
Evans RG.  Accessible, acceptable, and affordable: financing health care in Canada . In: The 1990 Richard and Hinda Rosenthal Lectures . Washington, DC: Institute of Medicine; 1990;:7-47.
Board of Trustees, American Medical Association. Study of the Canadian Health Care System . Chicago, Ill: American Medical Association; 1989;. Report V(A-89).
Evans RG.  Split vision: interpreting cross-border differences in health spending . Health Aff. 1988;;7( (4) ):17-24.
Fuchs VR, Hahn JS.  How does Canada do it? a comparison of expenditures for physicians' services in the United States and Canada . N Engl J Med. 1990;;323:884-890.
Beauchamp DE, Rouse RL.  Universal New York Health Care: a single-payer strategy linking cost control and universal access . N Engl J Med. 1990;;323:640-644.
Enthoven A, Kronick R.  A consumer choice health plan for the 1990s: universal health insurance in a system designed to promote quality and economy . NEngl J Med. 1989;;320:29-37,94-101.
Jones SB.  Can multiple choice be managed to constrain health care costs? Health Aff. 1989;;8( (3) ):51-59.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

US Bipartisan Commission on Comprehensive Health Care. A Call for Action . Washington, DC: The Pepper Commission on Comprehensive Health Care; 1990;.
National Leadership Commission on Health Care. For the Health of a Nation . Ann Arbor, Mich: Health Administration Press; 1989;.
Health Access America . Chicago, Ill: American Medical Association; 1990;.
Kennedy E. Senate Bill S.768. November 20, 1989.
Woolhandler S, Himmelstein DU.  Resolving the cost/access conflict: the case for a national health program . J Gen Intern Med. 1989;;4:54-60.
Grumbach K.  National health insurance in America: can we practice with it? can we practice without it? West J Med. 1989;;151:210-216.
Himmelstein DU, Woolhandler S.  A national health program for the United States: a physicians' proposal . N Engl J Med. 1989;;320:102-108.
Woolhandler S, Himmelstein DU.  A national health program: a northern light at the end of the tunnel . JAMA. 1989;;262:2136-2137.
Health Care Financing Administration.  National health expenditures: 1986-2000 . Health Care Financing Rev . 1987;;8( (4) ):1-36.
Needleman J, Arnold J, Sheils J, Lewin LS. The Health Care Financing System and the Uninsured . Washington, DC: Lewin/ICF; 1990;.
Newhouse JP, Manning WG, Morris CN, et al.  Some interim results from a controlled trial of cost sharing in health insurance . N Engl J Med. 1981;;305:1501-1507.
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;;289:1174-1178.
McDonald AD, McDonald JC, Salter V, Enterline P.  Effects of Quebec Medicare on physician consultation for selected symptoms . N Engl J Med. 1974;;291:649-652.
Brook RH, Ware JE Jr, Rogers WH, et al.  Does free care improve adults' health? results from a randomized controlled trial . N Engl J Med. 1983;;309:1426-1434.
Eisenberg JM. Doctors' Decisions and the Cost of Medical Care . Ann Arbor, Mich: Health Administration Press; 1986;.
Wennberg J.  Outcomes research, cost containment, and the fear of health care rationing . N Engl J Med. 1990;;323:1202-1204.
Chassin MR, Kosecoff J, Park RE, et al.  Does inappropriate use explain geographic variations in the use of health care services? JAMA. 1987;;258:2533-2537.
Himmelstein D, Woolhandler S.  Cost without benefit: administrative waste in US health care . N Engl J Med. 1986;;314:441-445.
Aggregate Hospital Financial Data for California: Report Periods Ending June 30,1987—June 29, 1988 . Sacramento: California Health Facilities Commission; 1989;.
Gonzalez ML, Emmons DW. Socioeconomic Characteristics of Medical Practice . Chicago, Ill: American Medical Association; 1988;.
Iglehart J.  Canada's health system faces its problems . N Engl J Med. 1990;;322:562-568.
American Medical Association.  The administrative burden of health insurance on physicians . Socioeconomic Monitoring Survey Rep. 1989;;3:2-4.
National Health Expenditures . Ottawa, Ontario: Health and Welfare Canada; 1990;.
Grumbach K, Bodenheimer T.  Reins or fences? a physician's view of cost containment . Health Aff. 1990;;9( (4) ):120-126.
Last JM.  Controlling the smoking epidemic . Am J Prev Med. 1985;;1:1-3.
Wagstaff A, Van Doorslaer E, Paci P.  Equity in the finance and delivery of health care: some tentative cross-country comparisons . Oxford Rev Econ Policy. 1989;;5:89-112.
Levit KR, Freeland MS, Waldo DR.  National health care spending trends: 1988 . Health Aff. 1990;;9( (2) ):171-184.
Reinhardt UE.  Health insurance for the nation's poor . Health Aff. 1987;;6( (1) ):101-112.
Levit KR, Freeland MS, Waldo DR.  Health spending and ability to pay: business, individuals, and government . Health Care Financing Rev. 1989;;10( (3) ):1-11.
Pechman JA. Federal Tax Policy . Washington, DC: The Brookings Institution; 1987;.
Bergthold LA. Purchasing Power in Health . New Brunswick, NJ: Rutgers University Press; 1990;.
DiCarlo S, Gabel J.  Conventional health insurance: a decade later . Health Care Financing Rev. 1989;;10( (3) ):77-89.
Bureau of the Census. Statistical abstract of the United States 1990 . Washington, DC: US Dept of Commerce; 1990;.
Bureau of the Census. Quarterly Summary of Federal, State, and Local Tax Revenue, July-September 1989 . Washington, DC: US Dept of Commerce; 1990.
Congressional Budget Office. Reducing the Deficit: Spending and Revenue Options . Washington, DC: The Congress of the United States; 1990;.
Blendon RJ, Donelan K.  The public and the emerging debate over national health insurance . N Engl J Med. 1990;;323:208-212.
Aaron H, Schwartz WG.  Rationing health care: the choice before us . Science. 1990;;247:418-422.
 International comparisons of health care financing and delivery: data and perspectives . Health Care Financing Rev. 1989;; 10( (suppl) ):1-196.
Pfaff M.  Differences in health care spending across countries: statistical evidence . J Health Polit Policy Law . 1990;;15:1-24.
Evans RG, Lomas J, Barer ML, et al.  Controlling health expenditures: the Canadian reality . N Engl J Med. 1989;;320:571-577.
Evans RG.  Accessible, acceptable, and affordable: financing health care in Canada . In: The 1990 Richard and Hinda Rosenthal Lectures . Washington, DC: Institute of Medicine; 1990;:7-47.
Board of Trustees, American Medical Association. Study of the Canadian Health Care System . Chicago, Ill: American Medical Association; 1989;. Report V(A-89).
Evans RG.  Split vision: interpreting cross-border differences in health spending . Health Aff. 1988;;7( (4) ):17-24.
Fuchs VR, Hahn JS.  How does Canada do it? a comparison of expenditures for physicians' services in the United States and Canada . N Engl J Med. 1990;;323:884-890.
Beauchamp DE, Rouse RL.  Universal New York Health Care: a single-payer strategy linking cost control and universal access . N Engl J Med. 1990;;323:640-644.
Enthoven A, Kronick R.  A consumer choice health plan for the 1990s: universal health insurance in a system designed to promote quality and economy . NEngl J Med. 1989;;320:29-37,94-101.
Jones SB.  Can multiple choice be managed to constrain health care costs? Health Aff. 1989;;8( (3) ):51-59.
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