Sanders: Single-Payer is Only System that Can Achieve Universal Health Care

Posted Jan. 20, 2016

MP3 Interview with Robert Zarr, president of Physicians for a National Health Program, conducted by Scott Harris


One of the defining issues separating the two major candidates vying for the Democratic party's presidential nomination is disagreement on the need to establish a single-payer health care system in the United States. While independent Vermont Sen. Bernie Sanders advocates such a system, sometimes referred to as Medicare for All, his opponent, former Secretary of State Hillary Clinton says the proposal would be too expensive for taxpayers and is not politically viable.

Clinton and her campaign have accused Sanders of promoting a plan that would do away with the Affordable Care Act, or Obamacare, and effectively end Medicare, Medicaid, the Children's Health program and other government healthcare benefits. In response, Sanders asserts his proposal would provide universal health care for the first time in U.S. history, repairing the major deficiencies in Obamacare that has left 29 million Americans without health insurance and many more uninsured. The U.S., Sanders repeatedly reminds his audiences, is the only industrial nation in the world today without a universal health care system.

Between The Lines' Scott Harris spoke Dr. Robert Zarr, president of the group Physicians for a National Health Program and a board-certified pediatrician at Unity Health Care in Washington, D.C. Here, Dr. Zarr assesses the validity of Clinton's criticisms of Sanders' advocacy of a single-payer system and the relative strengths and weaknesses of President Obama's Affordable Care Act.

DR. ROBERT ZARR: Single-payer national health insurance, as it's described in a physicians' proposal that was published in JAMA (Journal of The American Medical Assocation) back in 2003, and as it's largely represented in two pieces of legislation – HR 676 which is John Conyers' bill as well as Sanders' companion bill, which is 1782 – would take a program called Medicare that been around, established since 1965 and improve it and expand it. In fact, the title of HR 676, which is Conyers' single-payer bill is called "Expanded and Improved Medicare for All." So, to say that there would be any dismantling is simply not true, it would build on what we have currently in this country, which is single-payer for Americans over the age of 65.

I think it's more accurate to say we would take funds to pay for the programs that Hillary Clinton has listed – take that money and roll it into a Medicare fund and by doing that then you have enormous administrative savings. And it's through that administrative savings that you see at least $400 billion saved a year, which can then be a big part to describe how we can provide every American finally, with a national health insurance card, which means very, very generous basket of benefits from birth to death. That's really what needs to be said to the American public. I wouldn't use the the word "dismantling;" it's not quite capturing the essence of Medicare for All, which is taking a program that runs fairly efficiently. We're talking about an overhead of about less than 3 percent, which is in huge contrast to private insurance companies, which runs in the double digits, often as high as 18 percent, [therefore] taking Medicare's administrative efficiency there and using it to provide care for everybody.

BETWEEN THE LINES: Dr. Robert Zarr, Hillary Clinton places her bets on reforming and expanding the Affordable Care Act, Obamacare, to get to a more inclusive system moving towards universal health care, whereas Bernie Sanders says we really have to bypass the current structure of the ACA. Is it possible to reform and expand the Affordable Care Act to move toward universal health care? Or do we really have to moveto an entirely different system as Bernie Sanders' claims?

DR. ROBERT ZARR: It's not really a matter of my opinion. It's a matter of science. It's a matter of listening to data. So, I think at the end of the day, if someone says to you, we've got more than two decades of really solid, foundational health policy research that shows hands down that there is no other way that we know of in the world to provide health care from the day you're born to the day you die, give you very, very generous basket of benefits and do it a very efficient and cost-effective manner and not single-payer, it would be false and misguiding if I said anything else. Physicians for a National Health Program is, as you know, a nonpartisan organization, and being a nonprofit, we don't endorse candidates. We're about telling the truth. And I think that's why so much of the world looks us as an example of where facts really lie.

So, this really has very little with my opinion and it has to do with facts. And the facts will never change. The facts are that we cannot continue to rely on a system that depends on a for-profit driven industry whose main motive is profit for their shareholders. We need to move to a system that is efficient and encourages quality, is equitable and provides for every American without bankrupting the country and individuals for the years to come. Now that's the truth, and whether we choose to believe that or not, that's one thing. But we're really an organization who's tasked with analyzing data to guide sound health care policy. Politics is a whole other discussion which I am not an expert. But I can tell you from my health policy perspective, there are few people in this country who would disagree with the facts.

BETWEEN THE LINES: Dr. Robert Zarr, as we close here, what is your hope for the debate over single-payer in this 2016 presidential campaign?

DR. ROBERT ZARR: Physicians like myself and the public at large are thrilled that we're talking about this again. The majority of physicians support the creation of national health insurance. We've had survey after survey of the American public who support expanding and improving Medicare. So my hope is this kind of issue be raised again and again during the next few months so that we have a chance to educate and I hope also, to activate our population in this country to do something about this, because there is a solution to our nightmare and it's called single-payer national health insurance.

For more information, visit Physicians for A National Health Program at

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