More physicians support single-payer health care


Fifty-nine percent of U.S. physicians now support a federally administered health insurance fund that would guarantee health care coverage for everyone, according to a report published in the April 1 2008 issue of the Annals of Internal Medicine. The current support represents a 10 percent increase from a similar national survey in 2002. Among Minnesota physicians, the support for health care financing reform appears to be even higher and tied more specifically to a single-payer system.

Last year, Minnesota Medicine magazine reported its results from the first-ever random sampling of state-licensed physicians. Physicians were asked what type of health care financing structure they’d prefer among three choices: single-payer, health savings accounts (tax-free savings accounts to which individuals and employers contribute), and managed care (market-based private insurance plans). Sixty-four percent said a single-payer financing system would provide “the best health care to the greatest number of people for a fixed amount of money,” according to the Minnesota Medicine report.

A single-payer system would be a single plan managed and funded by just one entity, likely the government or a publicly accountable commission. Other universal health care plans currently under discussion would extend insurance coverage to more citizens through a combination of private, for-profit, non-profit and government organizations. A single-payer system would be less costly, say proponents, or more costly, according to opponents.

“Across the board, more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy,” said Ronald Ackermann, co-author of the national study and associate director of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine.

“I find the survey results energizing,” said Ann Settgast, a primary care physician in St. Paul, who along with Elizabeth Frost, another St. Paul physician, co-chairs the Minnesota chapter of Physicians for a National Health Program (PNHP). . “In five years (since the last survey) there’s been a dramatic 10 percent increase in positive responses. That shows a trend for sure.”

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PNHP-MN was formed last summer and has grown to 200 members. Most are in the Twin Cities but there’s growing representation from Duluth, Rochester and Mankato, Settgast said.

PNHP has about 15,000 members nationally, making it one of the largest medical associations in the country. A core belief of PNHP is that all people have a right to access high quality health care. Health care should be provided “equitably as a public service rather than bought and sold as a commodity,” according to the state chapter’s web site.

About 30 of the group’s more active members meet monthly and have spoken to civic, educational, and political organizations. In February PNHP-MN members testified in support of Sen. John Marty’s single-payer bill. Settgast said she’s “heartened” by the response the single-payer advocates have gotten after speaking with other physicians and joining in the public dialogue over health care reform. “We get a good reception,” added Settgast. “I don’t feel ‘fringe-y.’”

Until recent years, universal single-payer advocates were dismissed as being part of the fringe or ‘socialists,’ in a derogatory way. But as health care costs have risen out of the reach of millions more people, and disparities in health outcomes have grown between rich and poor and among racial and ethnic populations, public attitude has done an about-face.

In 2003, a single-payer “Medicare-for-all” type system drafted by Physicians for a National Health Program, was published in JAMA, the AMA journal. It was the impetus for the proposed National Health Insurance Act (HR 676) introduced in 2006 by U.S. Representatives John Conyers (D-Michigan) and Dennis Kucinich (D-Ohio).

PNHP-MN is taking out a full-page ad in the May issue of Minnesota Physician that asks colleagues to sign on to a resolution supporting HR 676, and encourage more Minnesota physicians to join the state chapter.

Even with a clear majority of support from citizens and growing physician support, a national health care program may come from incremental enactment through individual states rather than through federal legislation. HR 676 is stagnant with 88 co-sponsors. No new action has been taken on the bill since February 2007 when it was referred to two subcommittees on health.

None of the leading presidential candidates supports a single-payer or Medicare-for-all type health care system at this time. The Association of Health Care Journalists has a summary of the Democratic and Republican candidates’ plans on its web site. (When asked months ago if it planned to include all presidential candidates health care plans, including declared Green Party candidate Cynthia McKinney’s, AHJC president Len Bruzzese indicated he would bring it before the board for a decision. As of today, McKinney’s views are still absent from the site. Ironically, the health care proposals of candidates who have dropped out of the presidential race are still featured.)

As the public grows more impatient with government gridlock over health care, umbrella organizations like the Minnesota Universal Health Care Coalition with 15 member organizations (including PNHP-MN) are being replicated in state after state. Everybody In, Nobody Out, managed by North Carolina community organizer Dennis Lazof, maintains a database of citizens groups in each state.

Kathlyn Stone is an independent journalist in St. Paul. She maintains a health and science news site at She can be reached at