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Comment and Controversy

Time has come for single-payer system

March 2004 · Vol. 16, No. 3

To the Editor:

I read with interest Dr. Robert L. Barbieri’s November 2003 editorial, “Universal health coverage: Maine braves a new world.” As he observed, “many business and health industry leaders” in Maine considered that state’s universal, single-payer health plan “too radical” and “unacceptable.” But the United States as a whole employs a pluralistic system that now leaves approximately 43 million people with no insurance. Keeping that pluralism in place and reinventing the wheel is no solution.

Just because “the leaders” consider the single-payer plan too radical is hardly an argument against it. It is time for all who are interested in universal health care to recognize the need for a single payer. Those who reject this concept are accepting the status quo by default.


Dr. Barbieri responds:

I appreciate Dr. Ellison’s observations, including his conviction that we should move in 1 step from our current system to a single-payer health plan. The 8,000 doctors who signed the Physicians’ Working Group for Single-Payer National Health Insurance also agree with him.1 However, many leaders in government and health care believe there are advantages to evolving to a new system through multiple smaller steps. Given the pluralistic nature of American economic and political thought, it is likely that a multistep process, however flawed, will be the practical approach in our situation.


1. Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance. JAMA 2003;290:798-805.

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