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Toward a Comprehensive, Universal National Health Program

Policy Date: 1/1/1995
Policy Number: 9502

The American Public Health Association,
Recognizing that equal opportunity to attain and maintain good health should be the central goal guiding the financing and provision of health care; and
Having developed comprehensive criteria for a national health care program that would remove financial, organizational, and social impediments to achieving this goal; 1 and
Having, pursuant to those criteria, consistently supported a national tax-based single-payer plan, 2 because of its simplicity, its capacity to contain national health care expenditures without jeopardizing the nation's health,3,4 and its facilitation of public accountability; and
Recognizing that the need for such a program becomes more urgent as insurance coverage declines and health care becomes increasingly unaffordable for many U.S. residents;5-8 and
Realizing that, unless aggregate national expenditures for health care are contained, payer-driven efforts to limit costs are likely to result in cost shifting and would possibly worsen patient outcomes; and
Recognizing the nation's seriously deteriorating public health infrastructure; 9,10 and
Considering that, to assure the availability and accessibility of prevention programs and essential community providers, a major emphasis on community-based public health programs is needed; and
Concerned that the past year has witnessed wholesale for profit corporatization of U.S. health care, with a pronounced trend toward profit maximization and oligopoly;11-15 and
Believing that a privately capitalized, profit-maximizing health care industry is unlikely to be the route to cost-effectiveness and universal access, and, that unless effective regulation of that industry can be instituted, adoption of single-payer is unlikely to yield the savings usually associated with single-payer unless the entrepreneurial model on which health care is currently being reorganized is abandoned; and
Reaffirming its support for legislation to achieve universal, comprehensive health care, legislation that reflects the Association's 14 principles for a national health care program and that covers all residents of the United States, Puerto Rico, the Northern Marianas, and U.S. territories, regardless of legal resident or immigration status; and, to this end;
Reaffirming its support for a single-payer approach to health care financing, with provision for (a) fair payment to providers, via mechanisms that will minimize incentives either to overserve or to underserve, and (b) planning and evaluation with participation by both consumers and providers; therefore
1. Urges strengthening of public health programs, with a major emphasis on essential public health services and community-based programs as essential parts of a national health program, with funding at a level of at least 3 percent of all health expenditures;
2. Urges the President and Congress to take all necessary steps to propose and enact legislation to achieve these ends;
3. Urges Congress, in the interim, to facilitate state initiatives and ERISA (Employee Retirement Income Security Act) waivers to extend and expand coverage, including state-level single-payer initiatives;
4. Urges Congress and U.S. health care researchers to institute studies of the impact of corporatization in the health care system upon cost-effectiveness and accessibility of health care, so that Congress can respond with legislation to protect the public; and
5. Supports proposals that would extend and/or expand coverage incrementally, so long as (a) they are consistent with APHA's established criteria, (b) their adoption can be considered a step toward universal coverage and unlikely to impede enactment of a single-payer system, and (c) they would not reduce the levels of existing services and protections before replacements of at least equivalent scope and quality become available.

References


  1. A National Health Program for All of Us. Washington, DC: American Public Health Association; 1993.

  2. Toward a Comprehensive, Universal National Health Program. "Late-breaking" resolution adopted by APHA Governing Council, October 27, 1993, San Francisco, CA. APHA.

  3. Canadian Health Insurance: Lessons for the United States. Washington, DC: General Accounting Office; 1991. GAO/HRD-91-90.

  4. Congressional Budget Office analysis as reported by D. Priest, The Washington Post, December 17, 1993.

  5. Current Population Surveys. Health Insurance Coverage. Annual updates, 1988-1993. Washington, DC: Bureau of the Census.

  6. Blendon RJ, Donelan K, Hill CA, et al. Paying medical bills in the United States: Why health insurance isn't enough. JAMA. 1994;271:949.

  7. Blendon RJ, Scheck AC, Donelan K, et al. How White and African Americans view their health and social problems. JAMA. 1995;273:341.

  8. EBRI Databook on Employee Benefits, 1995.

  9. Smith DR. Porches, politics and public health. Am J Public Health. 1994;84:(5) 725-726.

  10. Projections of National Health Expenditures. Washington, DC: Congressional Budget Office, 1993.

  11. Tomsho R. Giant hospital chain uses rough tactics to push fast growth. Wall Street Journal. July 12, 1994.

  12. Anders G, Stout H. With Congress stalled health care is shaped by the private sector. Wall Street Journal. August 26, 1994.

  13. Hofmeister S. A $3.3 billion hospital deal is proposed. New York Times. Oct-ober 12, 1994.

  14. Peterson I. Health care and hospital chains. New York Times. November 15, 1994.

  15. Major healthcare deals of 1994. Jenks Healthcare Business Rept. 1995;6(8):3.

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