A Single-Payer Statewide Health Insurance System for Illinois
Single-payer health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.
Currently,. health care in Illinois - as in all of America - is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates. Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 46 million completely uninsured (1.8 million in Illinois) and millions more inadequately covered.
The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes one-third (31 percent) of Illinoisans’ health dollars.
Single-payer financing is the only way to recapture this wasted money. The potential savings on paperwork - more than $13 billion per year in Illinois - are enough to provide comprehensive coverage to everyone without paying any more than we already do.
Under a single-payer system, all Illinoisans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.
Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO / group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.
A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled though negotiated fees, global budgeting and bulk purchasing.
The links below will lead you to more specific information on the details of single-payer:
National Single-Payer Overviews
The Physicians Proposal for National Health Insurance
“Proposal of the Physicians’’ Working Group for Single-Payer National Health Insurance,” JAMA 290(6): Aug 30, 2003
Key Features of Single-PayerA useful handout detailing the main features of single-payer.
Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act
A great overview of the need for and logic of a single-payer system. Perfect as an introductory handout.
Liberal Benefits, Conservative Spending
Another great introductory handout.
Public Citizen's Response to the Citizens' Health Care Working Groups Interim Recommendations
A great overview on the benefits of a single-payer system by Public Citizen.
Rep. Dennis Kucinich Tackles Health Care
Rep. Kucinich talks with Truthdig about the health care crisis in America.
Single Payer: Facts and Myths
Single Payer FAQ
A frequently-updated catalog of the most-asked questions about single-payer.
Myths as Barriers to Health Care Reform
A paper refuting many of the myths associated with single-payer.
“Mythbusters” by the Canadian Health Services Research Foundation
A series of brief papers debunking the common misconceptions about the Canadian health system.
“Moral Hazard:” The Myth of the Need for Rationing
Rasell, E “Cost Sharing in Health Insurance – A Reexamination,” New Eng J Med., 332(7) 1995
Roos, et al “Does Comprehensive Insurance Encourage Unnecessary Use?” Can. Med. Assoc. J 170(2) Jan. 20, 2004
Gladwell, M. “The Moral Hazard Myth,” New Yorker Aug. 29, 2005
Health Economics and Financing
Introduction: How Much Would a Single-Payer System Cost?
A review of government and independent studies of the cost of single-payer system.
Administrative Waste Consumes 31 Percent of Health Spending
Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003
Administrative Costs in U.S. Hospitals are More Than Double Canada’sWoolhandler, et al “Administrative Costs in U.S. Hosptials,” NEJM 329, Aug. 5, 1993
60 Percent of Health Spending is Already Publicly Financed, Enough to Cover EveryoneWoolhandler, et al. “Paying for National Health Insurance – And Not Getting It,” Health Affairs 21(4); July / Aug. 2002
A Proposal for Financing National Health InsuranceRasell, Edith “An Equitable Way to Pay for Universal Coverage,” International Journal of Health Services. 29(1); 1999
"Liberal Benefits, Conservative Spending"Grumbach, et al. JAMA, May 15, 1991, Vol. 265 No. 19
The Case Against For-Profit Care
Overview: The High Costs of For-Profit Care
Editorial by David Himmelstein, MD and Steffie Woolhandler, MD in the Canadian Medical Association Journal
For-Profit Hospitals Cost More and Have Higher Death RatesDevereaux, PJ “Payments at For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J., Jun 2004; 170
Devereaux, PJ “Mortality Rates of For-Profit and Non-Profit Hospitals,” Can. Med. Assoc. J, May 2002; 166
For-Profit Hospitals Cost More and Have Higher Administration ExpensesHimmelstein, et al “Costs of Care and Admin. At For-Profit and Other Hospitals in the U.S.” NEJM 336, 1997
For-Profit HMOs Provide Worse Quality CareHimmelstein, et al “Quality of Care at Investor-Owned vs. Not-for-Profit HMOs” JAMA 282(2); July 14, 1999
For-Profit Medicare Plans Cost 11 Percent More Than Traditional MedicareMedPac Report, Jun 9, 2006
Quality and Malpractice
Introduction: Medical Malpractice, Health Care Quality and Health Care Reform (pdf)
A Forum Report by Gordon Schiff, MD
How Single-Payer Improves Health Care Quality (pdf)
A brief by PNHP (makes a great handout!)
Schiff, et al “A Better Quality Alternative” JAMA, 272(10); Sept. 12 1994
Comprehensive Quality Improvement Requires Comprehensive Reform (pdf)Schiff, et al “You Can’t Leap a Chasm in Two Jumps,” Public Health Reports 116, Sept / Oct 2001
The Failures of Other Reform Options
Individual Mandates (The Massachusetts Plan)
Consumer Directed Health Care and Health Savings Accounts
Tax Credits for Private Insurance
Why HSAs Won't Cure What Ails U.S. Health Care
Critique of Sen. Wyden's (OR) "Healthy Americans Act"
Comparison between Schwarzenegger Health Plan and Single Payer for CaliforniaState Single-Payer Bills
International Health Systems
I. Canada
The Canadian Health System: Lessons for the United States
US General Accounting Office Report, June 1991
A Survey of the Canadian Health System
Armstrong, et al “A Perfect System?” excerpted from Universal Health Care, New York Press, 1998
A Survey of Studies Comparing the U.S. and Canada (pdf)PNHP Brief, May 2006
The Future of Health Care in Canada (pdf)
Report of the Romanow Commission
II. International Comparisons
The U.S. spends more for less because of its fragmented financing system
Anderson, G. et al, "It’s the Prices, Stupid: Why the United States is so Different from Other Countries," Health Affairs 22(3), May/June 2004
U.S. Care Quality is No Better Than Other CountriesHussey, P. et al "How Does the Quality of Care Compare in Five Countries?" Health Affairs 23(3) May/June 2004
Single-Payer Bibliography
A bibliography of single-payer studies and papers