We Don’t Just Need Medicare for All —
We Need a National Health System

May 2, 2023
An Interview With Steffie Woolhandler David U. Himmelstein


Physicians for a National Health Program (PNHP) emerged thirty-five years ago amid the austerity cuts of the Reagan administration, which threatened to hollow out critical social safety-net programs like Medicaid. Rather than marshaling physician support to defend the limited (albeit lifesaving) poverty program, PNHP opted instead to pour its energies into expanding the possibilities of what health care reform could look like in the United States. From its inception, PNHP has committed itself to securing universal, comprehensive single-payer national health insurance. Under a single-payer system, all residents of the United States would be covered for all medically necessary services paid for by progressive taxation.
Since the turn of the twentieth century, both US political parties have faithfully accommodated private interests in their proposed health policy reforms. When doctors David Himmelstein and Steffie Woolhandler cofounded PNHP in the 1980s, support for single-payer health care was largely restricted to the radical left and a handful of progressive policy analysts. The doctors’ belief in health care as a public good emerged from their left-wing commitments and their personal experiences having witnessed the unnecessary suffering of patients in the current system. Later, as researchers, they published groundbreaking studies exposing private insurers’ administrative bloat, waste of resources, and widespread denial of care, revealing a health system in desperate need of transformation.
Writing in the Annals of Internal Medicine in 1988, Woolhandler and Himmelstein offered an explicitly Marxist understanding of the political economy that drives American medicine, a system of extraction that generates profit at the expense of patient health and physician autonomy. The authors envisioned an alternative health care system in the United States that would meet the needs of people, not corporations. “A reorientation of policy will require an alternative coalition of forces capable of resisting the imperatives of pecuniary interests,” wrote Wooldhandler and Himmelstein. “Physicians together with other health care workers and our patients may provide such a force.”
Unfortunately, the diagnosis is now even more dire than it was when PNHP was founded. The bad actors are no longer limited to private health insurers; American medicine is inundated by a powerful assortment of private interests from Big Pharma, giant hospital corporations, and private equity firms. Even retail giants like Walgreens, CVS, and Walmart are in on the grift. The private takeover of American medicine imperils the financial and physical health of millions of Americans. Suffice it to say that the prescription offered by PNHP’s physician-researchers remains as necessary today as it was thirty-five years ago.
For physicians and medical students fed up with the status quo, PNHP and its student wing SNaHP represent vital counterpoints to organizations allied with private interests such as the American Medical Association. PNHP today claims twenty-five thousand members representing all fifty states, with local chapters throughout the country. Data analysis by Himmelstein, Woolhander, and other researchers empowers PNHP members to make an evidence-based case for transformative health reform to their patients and their physician colleagues. Working alongside other single-payer standard-bearers like National Nurses United and Democratic Socialists of America, PNHP helped make single-payer, more popularly known as Medicare for All, a household concept. A 2020 Pew survey found that more Americans favor a single-payer system than any other option.
For Jacobin, Jonathan Michels sat down with Woolhandler and Himmelstein to commemorate PNHP’s thirty-fifth anniversary. They discussed PNHP’s inception, how the organization helped propel national health insurance back into the political debate, and the ways single-payer advocates must adapt for the next phase of the movement.