Demonstrators in Washington, D.C. rally for single payer healthcare on October 15, 2009. / Courtesy of Code Pink

Health care is a basic human need. The ability to get this care is a basic human right. When Thomas Jefferson wrote the immortal words, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness,” he was stating that all people have the right to equality under the law. Our Declaration of Independence was a call to liberate us from the tyranny and oppression of a ruling power that had no regard for the people they ruled.

Now, more than two centuries later, we are again besieged by oppression and discrimination. The control of health care by private insurers is no less a serious threat to life and liberty than the despotism against which our Founders fought so fiercely. Just ask the 45,000 Americans who will die needlessly each year because of a lack of health care. Ask their family members who must survive without them.

Universal single payer healthcare is a not-for-profit healthcare system that would provide equality of medical opportunity for all people living in the United States. Equality of opportunity is the foundation of our American democracy. Under Single Payer, all medical services and care would be paid by one non-profit funding agency or mechanism, as Medicare does today, without the 20 percent co-pay.

Covered care would include preventive care, dental, vision, mental health, palliative care and long term care. A single payer system would provide free choice of doctors and hospitals anywhere in the U.S (HMOs require you to get care in their own system), and allow doctors and patients to be in control of the best decisions for the patient. It would reduce waste and cut costs (the overhead for Medicare is 3 percent; it is 30 percent with private insurance companies). Single Payer/Medicare for All would cover everyone. Public oversight would insure the system is operating efficiently. Single Payer would ensure that we all would be given an equal chance to get treatment to heal and survive. This medical equality would reinforce the principles and ideals of our nation.

Although the Affordable Care Act is seen by some as a step to insure more people, it does not provide an equal opportunity for medical care. The ACA puts profits before patients. Under ACA, the insurance exchanges will be marketplaces where often confused and anxious consumers must compare and purchase health insurance. In the six quarters since ACA became law, private insurance companies saw their average operating profit margins expand to 8.24 percent (compared with 6.88 percent for the eighteen months before this bill was passed). Profits are certain to increase even more, starting in 2014, when the bill actually goes in effect.

The ACA is a tiered system and will not provide an equal opportunity to access health care and/or high quality care. The exchanges under ACA range from bronze, silver, gold, and platinum plans. Each plan offers different cost-sharing features – i.e., deductibles, co-payments, and coinsurance, which will determine the actuarial value of each plan. Bronze is valued at 60 percent, silver at 70 percent, gold at 80 percent, and platinum at 90 percent. In theory, people will buy the plan they think they’ll need or can afford. But how can you know in advance what you will need before you need it? What will happen if you can’t afford the plan you need?

This fall I attended the PNHP (Physicians for a National Health Program) annual conference in Washington, D.C. Dr. Claudia Fegan, PNHP past president, gave a moving and profound keynote speech, asking the question, “Why are we here?” Dr. Fegan reminded us that “we are here because every patient deserves to be treated with dignity and respect.” Quality healthcare is not just about making sure that everyone has insurance coverage; it’s about making sure that everyone has quality care. Everyone should have a chance to have the best possible outcome.

A crucial component missing from the Affordable Care Act that must be included in any bill that calls itself health care reform is palliative care. In January 2009, palliative care was included as a covered benefit in the single payer bill, HR 676. Palliative care provides coordinated, comprehensive care to alleviate pain and suffering for anyone who is given a life-threatening or life-altering diagnosis.

Palliative care is routinely provided by a team that includes physicians, nurses, chaplains, social workers, and others who work together with a patient’s own doctor to provide an extra layer of support for the patient and for the patient’s loved ones. It helps people to navigate the system, as well as to find pain relief, comfort, and cure if possible. Palliative care differs from hospice in that you are not required to have a six-month or less prognosis; curative and/or restorative treatment is allowed and provided.

The Law of Reciprocity, better known as The Golden Rule, states “Love thy neighbor as you would love thyself.” This principle is the core belief of nearly every religion and ethical system in the world. People need to be reminded that to be spiritually whole, they are obliged to take care of their neighbor. Combining Single-Payer/Medicare for All with the practice of Palliative Care would help to fulfill our sacred spiritual obligation.

Finally, to those people who do not understand these messages, we must ask: What would you do if your loved one were given a life-threatening or life-altering diagnosis and didn’t have health insurance or access to essential care and support? What would you do if it was you?


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