Universal Healthcare No. 135

Adopted 1997
Amended 1998
Amended 1999
Reaffirmed 2001
Amended 2003
Amended 2004
Amended 2005

Americans for Democratic Action supports single payer, comprehensive, high quality health care. The entire health care system in the United States is in a state of crisis. We urgently need to radically restructure radically what is now an anachronistic, fragmented, frequently dehumanizing and ineffective approach to the provision of health care.

Medical costs are rising at an alarming rate. Americans now spend an estimated $1.6 trillion/year on medical care - which is over 13% of our Gross Domestic Product (GDP) for the year 2003.

Yet, more than 44 million Americans have no medical insurance. Despite the recent expansion of CHIP and Medicaid, 11 million of the uninsured are children. At least 250,000 are homeless children. Thousands of expectant mothers have no pre-natal care. At least 31 million Americans are under insured. The gap in the quality of life between the affluent and the poor is widening and the gap in the quality of health care is widening still further. The problem is even worse for the rural poor. Rising costs and struggles with HMOs have made health care a middle class and upper middle class concern as well.

The cost explosion of medical care in the past two decades has deprived millions of Americans of peace of mind. Few Americans believe that they can adequately cope with a long-term illness.

Americans for Democratic Action was the first major group to propose a specific National Health Plan (1972). This proposal for a National Health Service was "single payer", funded with a progressive income tax, not limited by state boundaries, population based, and boldly addressed the maldistribution problems.

Our present health care system has many problems; these include:

Maldistribution -- Some of the worst health care in the developed world occurs in such areas as Eastern Tennessee and many other rural and inner city areas.
Poverty -- The poor in major urban centers are forced to get primary care in emergency wards, even though they may have Medicaid or other health insurance. The Children's Health Insurance Program intended to insure the 11 million uninsured children has not solved the problem.
Co-insurance -- The patient often must pay up to 20% of health care costs, which the poor and some of the middle class cannot afford. The numbers vary greatly, depending on the health plan, HMO, etc.
Deductibles -- The poor and some of the middle class cannot afford to pay the deductible.
Access denied -- Hospitals, which pride themselves on their increased efficiency, often do so by caring only for patients who have insurance.

The original ADA plan of 1972 and the modification approved in 1993 address these barriers to access. Following are the basic concepts behind ADA's plan:

I. A Single Payer Health Care System

The health care system must be organized, funded and regulated by the United States government. A "single payer" system means that the government negotiates the funding and sets the standards. The system:

Understands and supports the goal of universal coverage for all residents;
Eliminates involvement of insurance companies and their wasteful bureaucracies;
Has a single set of rules for reimbursement for all providers;
Neutralizes and ultimately eliminates the power of health care industry lobbies to inflate costs;
Provides for portability of benefits not tied to a job;
Maintains freedom of choice of care provider; and
Uses global budgeting to contain costs by controlling the rate of cost increases, tying them to GNP.

II. A Comprehensive Health Care System

A comprehensive health care system covers all residents of the U.S. This system:

Promotes and covers total health services, including but not limited to primary, secondary and tertiary care, mental health and substance abuse, dentistry, optometry and chiropractic and other delivery systems;
Fosters "wellness" and places emphasis on a full program of prevention which is universally practiced and which includes regular check-ups, multiphasic screening, and continuous individual, family and community education;
Provides long term care for all who need it;
Maintains a decent level of care for everyone; and
Acknowledges the dignity of dying patients.

III. An Affordable Health Care System

An affordable health care system contains costs. The system:

Is financed by a progressive tax structure with cost sharing by employers and employees;
Limits drug and pharmaceutical costs;
Meets long term costs based on the recipient's ability to pay; and
Effectively meets the challenge of malpractice.

IV. A High Quality Health Care System

A high quality health care system provides for quality care in response to citizens' needs. It:

Subsidizes medical education for clinicians (physicians, nurses and physicians' assistants);
Provides for salaried health care workers, clinicians and managers;
Supports research with an emphasis on effectiveness, enabling the health care system to determine what procedures are effective, who should receive them, etc;
Balances the needs for primary care and high technological services; and
Dramatically expands the national health service corps.

Achieving the goal of universal, comprehensive, high-quality and affordable health care will be long term and difficult. ADA believes that the nation has both the resources and the will to begin now.

ADA supports state initiatives toward universal health care that lead to the goals stated above.

Americans for Democratic Action has been committed to a National Health System since 1972 and continues to promote federally supported, universal, comprehensive health coverage, with a national health service which is population based and not limited by state boundaries.

We believe this National Health System must provide for (1) equal access to care; (2) no out-of-pocket expenses; (3) financing from a progressive income tax; (4) the exclusion of private insurers; and (5) cost containment along with solutions to maldistribution.

Given the present political climate, such a National Health System is not likely to be enacted yet. Therefore, in the same way that current Medicare was a large step toward an all encompassing, single payer system, we seek interim steps that will approach the goal and assist our most vulnerable populations, including guards against the abuses of HMOs through a strong, effective, and well-enforced National Patients' Bill of Rights. We also urge the expansion of Medicare to cover all children and pregnant women.

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No. 135
Social and Domestic Policy