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David U. Himmelstein, MD and Steffie Woolhandler, MD, MPH

The authors are with the Department of Medicine, Cambridge Hospital/Harvard Medical School, Cambridge, Mass, and Physicians for a National Health Program, Chicago, Ill.

Correspondence: Requests for reprints should be sent to David U. Himmelstein, MD, 1493 Cambridge St, Cambridge MA 02139 (e-mail: dhimmelstein{at}challiance.org).

Single-payer national health insurance could cover the uninsured and upgrade coverage for most Americans without increasing costs; savings on insurance overhead and other bureaucracy would fully offset the costs of improved care. In contrast, proposed incremental reforms are projected to cover a fraction of the uninsured, at great cost.

Moreover, even these projections are suspect; reforms of the past quarter century have not stemmed the erosion of coverage. Despite incrementalists’ claims of pragmatism, they have proven unable to shepherd meaningful reform through the political system.

While national health insurance is often dismissed as ultra left by the policy community, it is dead center in public opinion. Polls have consistently shown that at least 40%, and perhaps 60%, of Americans favor such reform.

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