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United States National Health Care Act

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Title: United States National Health Care Act  
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Subject: Health care reform in the United States, America's Affordable Health Choices Act of 2009, History of health care reform in the United States, Healthcare-NOW!, Health care in the United States
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United States National Health Care Act

United States National Health Care Act
Great Seal of the United States
Long title To provide for comprehensive health insurance coverage for all United States residents, improved health care delivery, and for other purposes.
Acronyms (colloquial) USNHCA / Single-Payer Health Care
Legislative history
  • Introduced in the House of Representatives as H.R. 676 by Rep. John Conyers (D-MI) on February 14, 2013
  • Committee consideration by Committee on Energy and Commerce, Committee on Ways and Means, Committee on Natural Resources
Health care reform in the United States
  • United States National Health Care Act (2009, H.R. 676)
  • Health Security Act (1993, H.R. 3600)
Latest enacted
Third-party payment models

The United States National Health Care Act, or the Expanded and Improved Medicare for All Act (H.R. 676), is a bill introduced in the United States House of Representatives by Representative John Conyers (D-MI).[1] The bill had 88 cosponsors in 2009. The act would establish a universal single-payer health care system in the United States, the rough equivalent of Canada's Medicare, the United Kingdom's National Health Service, and Taiwan's Bureau of National Health Insurance, among other examples. Under a single-payer system, all medical care would be paid for by the Government of the United States, ending the need for private health insurance and premiums, and probably recasting private insurance companies as providing purely supplemental coverage, to be used when non-essential care is sought.

The national system would be paid for in part through taxes replacing insurance premiums, but also by savings realized through the provision of preventative universal healthcare and the elimination of insurance company overhead and hospital billing costs.[2] An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.[3] Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care.[4] Preventative care can save several hundreds of billions of dollars per year in the U.S., because for example cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal.[5] Recent enactments of single-payer systems within individual states, such as in Vermont in 2011, may serve as living models supporting federal single-payer coverage.[6]

The bill was first introduced in 2003,[7] when it had 25 cosponsors, and has been reintroduced in each Congress since. During the 2009 health care debates over the bill that became the Patient Protection and Affordable Care Act, H.R. 676 was expected to be debated and voted upon by the House in September 2009,[8] but was never debated.[9] Advocates who remained staunchly for single-payer health care as the ultimate vote and passage of the America's Affordable Health Choices Act of 2009 loomed tried to present HR 676 as a viable alternative to the Affordable Health Care for America Act (H.R. 3962), but were ignored, and in some cases arrested by police during various nationwide debate events, and the bill never received significant public support.

Elements of the bill

The summary of the National Health Care Act includes the following elements, among others:[10]

  1. Expands the Medicare program to provide all individuals residing in the United States and U.S. territories with free (i.e. tax-funded) health care that includes all medically necessary care. This would include primary care and prevention, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
  2. Prohibits an institution from participating unless it is a public or nonprofit institution. Allows nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities to participate. On the whole, private insurances would be replaced with the new nationalized system for all basic, major care.
  3. Gives patients the freedom to choose from participating physicians and institutions—which, given the coverage of the new national system, would be any institution or clinic in the United States receiving any degree of public funding (i.e. the vast majority).
  4. Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows the private insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.
  5. Sets forth methods to pay institutional providers of care and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.
  6. Establishes the USNHC Trust Fund to finance the Program with amounts deposited: (1) from existing sources of government revenues for health care; (2) by increasing personal income taxes on the top 5% of income earners; (3) by instituting a progressive excise tax on payroll and self-employment income; and (4) by instituting a small tax on stock and bond transactions. Transfers and appropriates amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the State Children's Health Insurance Program. These taxes would be paid instead of insurance premiums, as the government (instead of private insurance companies) would be paying for the care under this single-payer system.
  7. Establishes a program to assist individuals whose jobs are eliminated (e.g., within insurance companies) due to the simplified single-payer administrative process.
  8. Requires creation of a confidential electronic patient record system.
  9. Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.
  10. Provides for: (1) the eventual integration of the Indian Health Service into the Program; and (2) evaluation of the continued independence of Department of Veterans Affairs (VA) health programs.
  11. The bill covers treatments on or after the first day of the year that begins one full year after passage (January 1, 2016 if the bill is passed in 2014). Compensation continues for 15 years to owners of converting for-profit providers for reasonable financial losses.

Cost analysis of the bill

Medical costs would be offset in part by replacing insurance premiums with taxes. Hundreds of billions of dollars of immediate savings would be realized from the elimination of insurance company overhead and hospital billing costs, but offsetting immediate expenses would include training and paying for the much larger number of general practitioners and other physicians necessary to provide coverage to several million formerly uninsured. Long term savings due to lower treatment and emergency room costs from preventative health care would be far greater.[4][5]

An analysis of the bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.[3] Others have estimated a larger long-term savings amounting to 40% of all national health care expenditures due to preventative care in addition to elimination of insurance company overhead costs.[4] Preventative health care expenditures can save several hundreds more billions of dollars per year because, for example, cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal.[5]

Paul Krugman described savings from elimination of insurance company overhead and hospital billing costs in 2005 as follows:[2]

The great advantage of universal, government-provided health insurance is lower costs. Canada's government-run insurance system has much less bureaucracy and much lower administrative costs than our largely private system. Medicare has much lower administrative costs than private insurance. The reason is that single-payer systems do not devote large resources to screening out high-risk clients or charging them higher fees. The savings from a single-payer system would probably exceed $200 billion a year, far more than the cost of covering all of those now uninsured.

Applying Krugman's $200 billion savings estimate to the U.S. population of approximately 300 million people representing 100 million households,[11] this amounts to approximately $650 per person or $2,000 per household. A study by Harvard University and the Canadian Institute for Health Information estimated the 1999 costs of U.S. health care administration at nearly $300 billion, accounting for 30.1% of health care expenses, versus 16.7% in Canada. This study estimated the U.S. per-person administrative cost at $1,059.[12] One organization that advocates nationalized health care estimated this savings could be as high as $350 billion per year in "...overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay."[13]


H.R. 676, though introduced in 2003, initially received little attention; with the June 2007 release of the Michael Moore documentary Sicko, which focuses on the status of health care in the only developed country without universal health care, interest in the Act was renewed.[14][15] The DVD edition of the film includes a segment (Sicko Goes To Washington) promoting the bill.[16][17][18]

In 2009 the bill was reintroduced and renamed from the United States National Health Insurance Act to the United States National Care Act, a reflection of the fact that the bill provides health care instead of providing health insurance. Health care was a major part of Barack Obama's campaign promises, and while he admitted that only a single payer system would provide universal coverage, the plan favored by Obama would be to increase insurance coverage instead. However, town hall remarks by Obama have indeed included support for a single payer system, particularly during his 2003-era pronouncements.[19] The bill was reintroduced in 2013.[1]


The bill proposes an expansion of the Medicare program to the non-elderly to provide universal coverage and allows individuals to select their own physicians. The bill would create a single-payer system, with Medicare replacing the 1,300 private insurance companies currently involved, which would reduce net costs between $100 and $250 billion annually, based on estimates. The savings relates to the approximately one-third of health care expenses that are spent on administrative overhead rather than medical service delivery. Also, rather than covering 80% of medical costs with the remaining 20% to be paid either out-of-pocket by the patient or via a privately underwritten "supplemental" insurance plan, as Medicare is structured now, HR 676 would cover 100% of all expenses. One of the alternative names for HR 676 among activists is "Medicare for All", but this is not quite fully accurate, given that if "Medicare for All" were all that really comprised HR 676, then the universal coverage would still need to pay the remaining 20%. Under HR 676 no one will need to do this. Activists claim they use "Medicare for All" as a slogan to increase ease of understanding of what single-payer is among the general U.S. populace, who, they contend, might not understand the scheme as well if a "full" explanation were given from the outset.

H.R. 676 does represent a significant expansion of government in health care, and is in fact the one example among health care plan options in the United States that would objectively qualify as a "government takeover" of the health insurance industry, though not of health care delivery itself. This is one of the primary arguments that opponents of the bill use when they come out against it. However, advocates do not see the prospect of a "government takeover of health insurance" as pejorative the way some others in the country do; they claim it is no different than "government-run" parks and recreation facilities, "government-run" police departments or "government-run" fire departments. Under HR 676 the government would be essentially replacing the foremost part of the private health insurance industry.[20] Conservatives historically have argued against the expansion of government programs, offering significant resistance to the current and prior health care reform efforts,[21] and the bill would raise taxes for higher-income individuals.[20] On July 30, 2009, Rep. Anthony Weiner offered Republicans an opportunity to oppose government-run health care programs by putting forth an amendment[22] that would eliminate Medicare.[23] Every single Republican representative (and every Democrat) on the House Energy and Commerce committee voted to continue Medicare.[24]

Medical tourism

Since the act covers all "residents," a section was added requiring the Secretary of HHS to create a rule addressing the possibility of medical tourism (Section 101(e)).

See also


  1. ^ a b "House Reps Introduce Medicare-for-All Bill" Becker's Hospital Review, Feb. 14, 2013
  2. ^ a b Krugman, Paul (June 13, 2005). "One Nation, Uninsured". The New York Times. Retrieved December 4, 2011. 
  3. ^ a b Physicians for a National Health Program (2008) "Single Payer System Cost?"
  4. ^ a b c Hogg, W.; Baskerville, N; Lemelin, J (2005). "Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis". BMC Health Services Research 5 (1): 20.  
  5. ^ a b c Levy A.R. et al. (2010). "International comparison of comparative effectiveness research in five jurisdictions: insights for the US". Pharmacoeconomics 28 (10): 813–30.  
  6. ^ "State-Based Single-Payer Health Care — A Solution for the United States?" New England Journal of Medicine 364;13:1188-90, March 31, 2011
  7. ^ H.R. 676
  8. ^ "Single Payer Gets A Vote (Updated)". Daily News (New York). July 31, 2009. 
  9. ^ "H.R. 676: United States National Health Care Act or the Expanded and Improved Medicare for All Act (". Retrieved December 1, 2009. 
  10. ^ "United States National Health Care Act – Summary". Retrieved December 4, 2011. 
  11. ^ "U.S. Census Report-Projection of Households and Families in the U.S" (PDF). Retrieved December 4, 2011. 
  12. ^ "Research Report-Harvard & Canadian Institute for Health Information-Costs of Healthcare Administration in the U.S. and Canada 2003" (PDF). Retrieved December 4, 2011. 
  13. ^ "PNHP-Single Payer National Health Insurance". Retrieved December 4, 2011. 
  14. ^ Insuring America's Health: Principles and Recommendations, Institute of Medicine of the National Academies of Science.
  15. ^ The Case For Single Payer, Universal Health Care For The United States, John R. Battista, M.D. and Justine McCabe, PhD
  16. ^ "American Health Care". American Health Care Retrieved December 4, 2011. 
  17. ^ Towards Universal Health Care
  18. ^ Universal Health Plan is Endorsed The Boston Globe August 13, 2003
  19. ^ "Town Hall Meeting on Health Care". Retrieved December 4, 2011. 
  20. ^ a b "Summary of the Bill". Retrieved December 4, 2011. 
  21. ^ The New Republic-Conservatism is Dead-Tanenhaus-February 2009
  22. ^ [1]
  23. ^  
  24. ^ "Committee on Energy and Commerce – 11th Congress: Roll call vote: Rep Weiner 06A". Committee on Energy and Commerce. 

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