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1. It's good for our health

1. S. Dorn, Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality (Washington. DC: Urban Institute, 2008).

2. E. Nolte and C.M. McKee, "Measuring the Health of Nations; Updating an Earlier Analysis," Health Affairs 27 (2008): 58-71.

3., "Doctor Contrasts His Cancer Care with Uninsured Patient Who Died" (April 11, 2007).

4. D. Grady, "2 New Approaches May Reduce Cervical Cancer Deaths for Poor," New York Times, November 2, 2005.

5. Organisation for Economic Cooperation and Development, DECO Health Data 2007. (Paris: DECO, 2007).

6. Save the Children, State of the World's Mothers 2006: Saving the Lives of Mothers and Newborns (Westport, CT: Save the Children, 2006).

7. K. Hill et al., "Estimates of Maternal Mortality Worldwide Between 1990 and 2005: An Assessment of Available Data," Lancet 370 (October 16, 2007): 1311-19.

8. OECD Health Data 2007.

9. L. Payer, Medicine and Culture (New York: Holt, 1996).

10. M. Roemer, National Health Care Systems of the World, Vol. 1 (Oxford and New York: Oxford University Press, 1991).

11. A. Shimo, "The rise of private health care in Canada," Maclean's, April 25, 2006.

12. Washington Post/ABC News Poll, October 20, 2003: Community Service Society/Lake Research, "Unheard Third," Question 11, 2007.

13. E. Smollett, personal communication, 2003.

14. L. Towell and S. Corbett, "Patients Without Borders," New York Times Sunday Magazine, November 18, 2007, 62-69.

2. It costs less and saves money (unlike all of the alternatives)

1. Kaiser Family Foundation and Health Research and Educational Trust (HRET), 2007 Kaiser/HRET Employer Health Benefits Survey. upload/Summary -of-findings-EHBS-2007.pdf (accessed September 11, 2007).

2. U.S. Department of Commerce, Bureau of the Census, Income, Poverty, and Health Insurance Coverage in the United States: 2006 (Washington, DC, August 2007).

3. Aaron Catlin et at, "National Health Spending in 2006: A Year of Change for Prescription Drugs," Health Affairs 27, no. l (2008): 14-29.

4. Organisation for Economic Cooperation and Development, DECO Health Data 2007 (Paris: OECD, 2007).

5. Ibid., and Commonwealth Fund, National Scorecard on US Health System Performance (New York, 2006).

6. Robert J. Blendon et al., "The Public Versus the World Health Organization on Health System Performance," Health Affairs 20 (2001): 3.

7. It is often claimed that Switzerland and, since 2006, the Netherlands rely on private insurance companies, as we do. It is true that these countries use private, including for- profit and nonprofit, insurance companies, but they operate under the most stringent government regulation. They must all offer the same standard benefit package, their premiums are regulated, and individuals pay according to their income, with government subsidy covering the rest. The government performs risk adjustment among the insurers, so there is no incentive for them to select only the healthiest persons and, in Switzerland, they are not permitted to earn a profit on the basic package of benefits.

8. John Holahan, The Cost of Care for the Uninsured (Washington, DC: Urban Institute, November 2005).

9. At $4,500 per person for the 47 million uninsured, private insurance would cost $212 billion. However, there would be less uncompensated care, and the Urban Institute study (ibid.) extrapolated to this year suggests that eliminating this and other costs paid for the uninsured would save about $60 billion.

10. (accessed October 24, Z007).

11. S. Woolhandler, T. Campbell, and D. Himmelstein, "Costs of Health Care Administration in the United States and Canada," New England Journal Of Medicine 349 (2003): 8.

12. James G. Kahn et al., "The Cost of Health Insurance Administration in California: Estimates for Insurers, Physicians, and Hospitals," Health Affairs 24 (2005): 6.

13. (accessed October 24, 2007).

14. See for a summary.

15. 2007 Kaiser/HRET Employer Health Benefits Survey.

16. OECD Health Data 2007.

17. The VA Hospital system should not be confused with hospitals operated by the U.S. Army such as the Walter Reed Army Medical Center, which has been the subject of recent negative press coverage because of substandard care for returning troops.

18. Philip Longman. The Best Care Anywhere: Why VA Health Care Is Better Than Yours (Sausalito, CA: PoliPointPress, 2007).

19.  (accessed November 27. 2007).

20. The Lewin Group, Health Care for All Californians Act; Cost and Economic Impacts Analysis (Falls Church: January 19, 2005).

3. It will assure high-quality health care for all Americans, rich or poor

1. S. Dorn, Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality (Washington, D.C.: Urban Institute, 2008).

2. E. Nolte and CM. McKee. (2008). "Measuring the Health of Nations: Updating an Earlier Analysis," Health Affairs 27 (2008): 58-71.

3. Kevin Sack, "Cancer Society Focuses Its Ads on the Uninsured," New York Times, August 31, 2007.

4. Future of Emergency Care report, Hospital-Based Emergency Care: At the Breaking Point, Institute of Medicine, June 2006.

4. It's the best choice -- morally and economically

1. Douglas Fraser, "Inside the 'Monolith'," in The State of the Unions, ed. George Strauss, Daniel G. Gallagher, and Jack Fiorito (Madison, WI: Industrial Relations Research Association, 1991), p. 413.

2. Ricardo Alonso-Zaldivar, "Q &A: A Labor Leader Talks Healthcare,", March 11, 2007,,1,2339035.print.story?ctrack=1&cset=true (accessed April 4, 2007).

3. For an elaboration of some of the main arguments in this chapter, see Marie Gottschalk, "Back to the Future? Health Benefits, Organized Labor, and Universal Health Care," journal of Health Politics, Policy and Law 32, no. 5 (December 2007): 923-70.

4. For more details on organized labor and the battle over the Clinton plan and on the development of private-sector health benefits, see Marie Gottschalk, The Shadow Welfare State: Labor, Business and the Politics of Health Care in the United States (Ithaca: Cornell University Press. 2000).

5. Comments made at "A Brookings Institution-New American Foundation Forum: Employment-Based Health Insurance: A Prominent Past. But Does It Have a Future?" Washington, DC, June 16, 2006, 20060616.htm (accessed July 18, 2006), p. 15.

6. George Raine, "Union leader Declares Health Care Is Priority," San Francisco Chronicle, November 4, 2006.

7. "A Brookings Institution-New America Foundation Forum," p. 9.

8. Uwe E. Reinhardt, "Health Care Spending and American Competitiveness," Health Affairs, Winter 1989: 5-20. See also Mark Pauly, Health Benefits at Work: An Economic and Political Analysis of Employment-Based Health Insurance (Ann Arbor: University of Michigan, 1997).

9. See Gottschalk, "Back to the Future," pp. 946-47, Figures 1 and 2.

10. Steven Greenhouse and David Leonhardt, "Real Wages Fail to Match a Rise in Productivity," New York Times, August 28, 2006. p. A-l.

11. Clifford J. Levy, "The New Corporate Outsourcing," New York Times, January 29, 2006, sec. 4, p. 1.

12. Pauly, Health Benefits at Work, p. 119.

13. Joe Nocera, "Resolving to Reimagine Health Costs," New York Times, November 18, 2006, p. C-l.

14. Cathy A. Cowan et al., "Burden of Health Care Costs: Business, Households, and Governments, 1987-2000," Health Care Financing Review 23: 3 (Spring 2002): Table 1, p. 136.

15. Cowan et al., "Burden of Health Care Costs," p. 132

16. For details of the unraveling of the private-sector benefits, see Gottschalk, "Back to the Future?" pp. 926-40.

17. Ellen E. Schultz, "Companies Sue Union Retirees to Cut Promised Health Benefits," Wall Street Journal, November 10, 2004, p. A-l.

18. Chris L. Peterson and Rachel Burton, "U.S. Health Care spending: Comparison with Other OECD Countries" (Washington, DC: Congressional Research Service, September 17, 2007), p. 1.

19. Uwe E. Reinhardt, Peter S. Hussey, and Gerard F. Anderson, "U.S. Health Care Spending in an International Context: Why Is U.S. Spending So High. and Can We Afford It?" Health Affairs 23. no. 3 (May/June 2004): 14. Exhibit 2.

20. Robert J. Blendon, Minah Kim. and John M. Benson. "The Public Versus the World Health Organization on Health System Performance." Health Affairs 20. no. 3 (May/June 2001): 16. Exhibit 1.

21. Henry J. Aaron, "The Cost of Health Care Administration in the United States and Canada-Questionable Answers to a Questionable Question," New England Journal of Medicine 349, no. 8 (August 21, 2003): 801.

22. Philip Maltera, "Taking the Profit Out of Health Insurance," New Labor Forum 16, no. 3-4 (Fall 2007): 51.

23. Ibid.

24. David U. Himmelstein, Steffie Woolhandler, and Sidney M. Wolfe, "Administrative Waste in the U.S. Health Care System in 2003: The Cost to the Nation, the States, and the District of Columbia. with State-Specific Estimates of Potential Savings," International Journal of Health Services 34. no. 1 (2004): 79-86.

25. Calculated from Himmelstein et al., p. 79.

26. John R. Commons, Institutional Economics: Its Place in Political Economy, vol. 2 (Madison: University of Wisconsin. 1961 [1934]).

27. Comments made at "A Brookings Institution -- New America Foundation Forum," p. 15. The S.E.I.U.'s Web site also proclaims, "It's Time for an American Solution to Our Health Care Crisis." See (accessed August 9, 2006); and Alonso-Zaldivar, "Q & A."

28. See, for example, Robin Toner and Janet Elder, "Most Support U.S. Guarantee of Health Care," New York Times, March 2, 2007, p. A-1.

29. Paul Krugman, "Big Table Fantasies," New York Times, December 17, 2007.

6. It will let doctors and nurses focus on patients, not paperwork

1. J. Needleman et al., "Nurse-staffing levels and the Quality of Care in Hospitals," New England journal of Medicine 346, no. 22 (2002): 1715-21; K. Chang, "Dimensions and Indicators of Patients' Perceived Nursing Care Quality in the Hospital Setting," Journal of Nursing Care Quality 11, no. 6 (1997): 26-37.

2. R.I.. Kane et al., Nurse Staffing and Quality at Patient Care, AHRQ Publication No.07- E005 (Washington, DC: U.S. Department of Health and Human Services, 2007); National Academy of Science. Keeping Patients Safe: Transforming the Work Environment of Nurses (2004). Retrieved December 23. 2007. from

3. L.H. Aiken et at. "Hospital Nurse Staffing and Patient Mortality. Nurse Burnout. and Job Dissatisfaction," Journal of the American Medical Association 288. no. 16 (2002): 1987-93.

4. Bodenheimer and Grumbach, Understanding Health Policy 4th ed. (New York: McGraw-Hill Medical, 2004).

5. H.J. Keeler and M.E. Cramer, "A Policy Analysis of Federal Registered Nurses Safe Staffing Legislation," Journal of Nurse Administrators 37, no. 7/8 (2007): 350-56.

6. Needleman et at, "Nurse Staffing Levels."

7. Aiken et al., "Hospital Nurse Staffing."

8. Keeler and Cramer, "A Policy Analysis."

9. Aiken et al., "Hospital Nurse Staffing."

10. Kane et al., "Nurse Staffing and Quality." California Nurses Association, RN-to-Patient Ratios: A Cost Effective Solution for Hospitals (2005). Retrieved December 23, 2007, from .

11. U.S. Department of Labor. Bureau of Labor Statistics, Registered Nurses (29-1111.00). Retrieved December 23, 2007, from

12. New York City Department of Health and Mental Hygiene. Triennial Report, 2004- 2006, "Public Health in New York City," p. 24.

13. Ian Urbina, "In the Treatment of Diabetes, Success Often Does Not Pay," New York Times, January 11, 2006.

7. It will reduce health care disparities

1. Centers for Disease Control and Prevention. National Center for Health Statistics, National Linked Files of Live Births and Infant Deaths, 2004,

2. C.C. Cowie et al., "Prevalence of Diabetes and Impaired Fasting Glucose in Adults in the U.S. Population: National Health and Nutrition Examination Survey 1999-2002," Diabetes Care 29 (2006): 1263-68.

3. A.K. Jha et al., "Racial Trends in the Use of Major Procedures among the Elderly," New England Journal of Medicine 353 (2005): 683-91.

4. Agency for Healthcare Research and Quality. National Healthcare Disparities Report, 2006,

5. C. DeNavas.Walt, B.D. Proctor, and C.H. Lee, U.S. Bureau of the Census, Current Population Reports, P60-231, "Income, Poverty, and Health Insurance Coverage in the United States: 2005" (Washington, DC: U.S. Government Printing Office, 2006).

6. U.S. Department of Commerce, Bureau of the Census, Table HI-4, "Health Insurance (overage Status and Type of Coverage by State All People: 1987 to 2005,"

7. N. Calman et al.. Separate and Unequal: Medical Apartheid in New York City (Bronx Health REACH Coalition, 2005),

8. It will eliminate medical debt

1. U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Expenditure Data.

2. Families USA; see Kaiser Daily Health Report, "Health Insurance Premium Rates Increase Faster Than Income, Study Says," October 18, 2006. The study examined premium growth from 2000 to 2006.

3. U.S. Department of Commerce, Bureau of the Census, "Income, Poverty, and Health Insurance Coverage in the United States: 2006," August 2007.

4. Paul Fronstin, "Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2006 Current Population Survey," Issue Brief No. 298, Employee Benefit Research Institute (EBRI), October 2006.

5. Mercer Human Resources Consulting, "2005 National Survey of Employer-Sponsored Health Plans," see Tab 4 at  Also see Paul Fronstin and Sara R. Collins, "Early Experience with High-Deductible and Consumer- Driven Health Plans: Findings from the EBRI/Commonwealth Fund Consumerism in Health Care Survey," EBRI and the Commonwealth Fund, Issue Brief No. 288, December 2005.

6. Kaiser Family Foundation/Health Research Educational Trust, "Employer Health Benefits 2007 Annual Survey," September 2007.

7. Jessica Banthin, Peter Cunningham, and Didem Bernard, "Financial Burden of Health Care, 2001-2004," Health Affairs 27, no. 1, 188-95 (Jan/Feb 2008).

8. Michelle M. Doty, Jennifer N. Edwards, and Alyssa L. Holmgren, "Seeing Red: Americans Driven into Debt by Medical Bills: Results from a National Survey," The Commonwealth Fund, August 2005.

9. ABC News, Kaiser Family Foundation, and USA Today, "Health Care in America 2006 Survey," October 2006.

10. See The Access Project, "The Consequences of Medical Debt: Evidence from Three Communities," February 2003: David U. Himmelstein et al. "Illness and Injury as Contributors to Bankruptcy," Health Affairs Web Exclusive, February 2, 2005: Jessica H. May and Peter J. Cunningham, "Tough Tradeoffs: Medical Bills, Family Finances and Access to Care," Center for Studying Health System Change, Issue Brief No. 85, June 2004; and Michelle M. Doty, Jennifer N. Edwards, and Alyssa L. Holmgren, "Seeing Red: Americans Driven into Debt by Medical Bills: Results from a National Survey," The Commonwealth Fund, August 2005.

11. Catherine Hoffman, Diane Rowland, and Elizabeth C. Hamel, "Medical Debt and Access to Health Care," Washington, DC: Kaiser Commission on Medicaid and the Uninsured, September 2005.

12. Himmelstein et al. "Illness and Injury."

13. Robert W. Seifert, "Home Sick: How Medical Debt Undermines Housing Security," Boston: The Access Project, November 2005.

14. Brian Grow and Robert Berner, "Fresh Pain for the Uninsured: As Doctors and Hospitals Turn to GE, Citigroup, and Smaller Rivals to Finance Patient Care, the Sick Pay Much More," Business Week, November 21, 2007.

15. Cindy Zeldin and Mark Rukavina, "Borrowing to Stay Healthy: How Credit Card Debt Is Related to Medical Expenses," New York: Demos and The Access Project, January 2007.

16. Carol Pryor, Andrew Cohen, and Jeffrey Prottas, "The Illusion of Coverage: How Health Insurance Fails People When They Get Sick," Boston: The Access Project, 2007.

17. Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits: 2006 Annual Survey, 2006.

18. See the Institute of Medicine, "Consequences of Uninsurance" series, several reports issued between 2001 and 2004.

19. Healthcare ARM Report, Rockville: Kaulkin Ginsberg, 2006.

9. It will be good for labor and for business

1. Consumer Reports, September 2007, 16-18.

2. Ibid.

3. Ibid.

4. U.S. Department of Commerce, Bureau of the Census, Income, Poverty, and Health Insurance Coverage in the United States: 2006 (Washington, DC, August 2007).

5. U.S. Department of Health and Human Services, Health United States 2007 (Washington, DC, November 2007).

6. Kaiser Family Foundation and Health Research and Education Trust, Survey of Employer Health Benefits 2007, September 2007.

7. Alan Sager, "Hospital Closings and Consolidations Won't Promote Sustainable Health Care for All in New York," Testimony before the Workers' Rights Board, Buffalo, New York, January 30. 2007.

10. It's what most Americans want -- and we can make it happen

1. Organisation for Economic Cooperation and Development, GECD Health Data 2007 (Paris, 2007).

2. U.S. General Accounting Office, Canadian Health Insurance: Lessons for the United States (Washington, DC: June 1991); U.S. Congressional Budget Office, Estimates of Health Care Proposals from the 102nd Congress (Washington, DC: July 1993).

3. C. Schoen et al., "Why Not the Best: Results from a National Scorecard on Health System Performance," Commonwealth Fund Commission on a High Performance Health System, New York, September 2006.

4. "Toward Higher-Performance Health Systems: Adults' Health Care Experiences in Seven Countries. 2007," Health Affairs Web Exclusive Vol. 26. No.6, p. W717. Exhibit 4.

5. L. Kowalczyk, "Dangerous Delays to see Skin Doctors," Boston Globe, January 7, 2007.

6. Richard Roetzheim et al., "Effects of Health Insurance and Race on Early Detection of Cancer," Journal of the National Cancer Institute 91. no. 16, (1999): 1409-15.

7. Kevin Sack, "Cancer Society Focuses Its Ads on The Uninsured," New York Times. September 7, 2007.

8. S. Dorn, Uninsured and Dying Because of It: Updating the Institute of Medicine Analysis on the Impact of Uninsurance on Mortality (Washington, DC: Urban Institute, 2008).

9. D. McCormick, D. Himmelstein, and S. Woolhandler, "Single-Payer National Health Insurance: Physicians' Views [in Massachusetts]", Archives of Int Med 164 (2004):300- 04.

10. American College of Physicians, Position Paper: "Achieving a High-Performance Health Care System with Universal Access: What the United States Can learn from Other Countries," Ann of Intern Med. 148 (2008):55-75.


12. Robert Pear, "Medicare Audits Show Problems in Private Plans," New York Times, September 2, 2007.

THIS MODERN WORLD, by Tom Tomorrow, 7/1/98
[Louise] Look at this, Harry!  It turns out that HMO's may not be any more cost-effective than the traditional fee-for-service plans they have largely replaced!
[Harry] Gosh, Louise, that's terrible!  If only there were another option!
[Louise] Yes, if only there were a system which provided universal coverage -- including the freedom to choose your own doctor -- while actually reducing health care costs --
[Harry] -- And which had already proven itself in other industrialized democracies!
[Louise] Well, I sure can't think of anything like that, Harry.
[Harry] Me either, Louise.
[Penguin] Sigh ... sometimes it doesn't matter if you DO hit them over the head ...

Between the health care that we now have and the health care that we could have lies not just a gap, but a chasm. -- Crossing the Quality Chasm

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