The Organisation for Economic Co-operation and Development's Health Data 2008 reported that in 2006, the United States spent $6,714 per capita on healthcare, which is approximately double what was spent in Canada, and more than double what was spent in other Western nations, such as the United Kingdom and New Zealand. Despite the spending, Americans don't seem to be getting good value for their money, for if you look at the figures, it's shocking.

The 2008 CIA World Factbook cites the infant mortality rate in the United States at 6.30 per 1,000 births, which is a higher rate than those in other Western nations, such as Canada (5.08), New Zealand (4.99), the United Kingdom (4.93), and Australia (4.51). The WHO's World Health Report 2005, whose focus was "Make Every Mother and Child Count," found US maternal mortality rates at 14 per 100,000 live births, compared with 11 for the UK, 10 for Japan, seven for New Zealand, six for Australia, and five for Canada. A September 2006 report from The Commonwealth Fund found that the American healthcare system's performance falls short on key indicators of health outcomes, quality, access, efficiency, and equity, with the US ranking 15 of 19 industrialized countries on mortality from conditions amenable to healthcare, or deaths before age 75 that are potentially preventable with timely, effective care.

But perhaps the best known and most shocking statistic concerns health insurance: An August 2008 report from the US Census Bureau found that 45.7 million people, or 15.3% of the population, were without health insurance in 2007. A 2003 Institute of Medicine study Hidden Costs, Value Lost: Uninsurance in America calculated that every year 18,000 Americans die prematurely due to uninsurance. Also now familiar to many are the statistics published in February 2005 in Illness And Injury As Contributors To Bankruptcy, which found that 50% of all bankruptcy filings were partly the result of medical expenses, and that every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem. For the United States, one of the richest nations on earth, and arguably the most powerful nation on earth, is the holdout among industrialized nations in that it lacks a form of single-payer or universal health insurance to serve all its people. There are groups that want this to change.

Physicians for a National Health Program (PNHP) was co-founded by Drs. David Himmelstein and Steffie Woolhandler in 1987. Himmelstein, an Associate Professor of Medicine at Harvard, explains, "I was one of a group of primary care doctors who were trying to do our work, but we found we couldn't take decent care of people. Our healthcare system wouldn't let us. The more we thought about it and looked into it, the more we realized that national health insurance was the only option that would work."

PNHP is a single issue organization advocating a universal, comprehensive single-payer national health program. PNHP educates physicians and other healthcare professionals about the benefits of a single-payer system – including fewer administrative costs and providing health insurance for the millions of Americans who have none. Group members perform research on the health crisis and the need for fundamental reform, and contribute scholarly articles to peer-reviewed medical journals. They participate in meetings and debates, and appear regularly in media advocating for a single-payer system.

Today, PHNP's membership includes more than 15,000 physicians, medical students, and other healthcare professionals. It is what Himmelstein terms the physician branch of a much larger movement endorsing a single-payer, national health insurance plan that includes groups as varied as Healthcare-NOW, the American Nurses Association, the National Association of Social Workers, almost two dozen municipal governments, numerous civic, labor, and religious organizations, and more.

A poll published earlier this year in Annals of Internal Medicine found 59% support among physicians for a national health insurance program. Public support for a national health program is even higher. A March 1, 2007 CBS News press release reported on a CBS News/New York Times poll that found 64% of Americans believe that the federal government should guarantee health insurance for all Americans, while only 27% said the government should not guarantee health insurance (9% didn't know or didn't respond). And an August 2008 survey commissioned by The Commonwealth Fund found that 82% of respondents agreed that the American healthcare system needs either fundamental change or complete rebuilding.

But if a national health program has so much support among Americans, why doesn't the United States have one? "Simply put," says Himmelstein, "there are huge amounts of money being made from current healthcare system. Corporate fortunes being made. Profits would be lost under a single-payer system."

Himmelstein believes that the insurance industry is the chief foe of a national health program. As he and fellow writing committee colleagues said in Proposal of the Physicians' Working Group for Single-Payer National Health Insurance (JAMA, August 13, 2003):

If the system were to change to a national program, these companies' raison d'être would disappear.

Other major foes, explains Himmelstein, are the drug and device companies which charge Americans unreasonable costs. "Canadians receive a 40% discount compared to what Americans pay; although, the VA does get this rate now." And finally are the for-profit providers, such as dialysis centers and nursing homes, which his research has found, provide lower quality care than do nonprofit organizations. For example, a 1999 study found that investor-owned HMOs scored worse than nonprofits on all 14 quality indicators reported to the National Committee for Quality Assurance.

Many politicians aren't willing to support a national health insurance program due to industry influence on politics. The insurance industry, for instance, has enormous amounts of money to provide for direct lobbying, political campaign contributions, research grants to sympathetic sources, and direct advertising to the public.

"A key to discouraging support for a national health plan is to try to convince people that someone who has insurance would be worse off – for example, that you would be denied what you now have. There is evidence counter to that, but you can always tell lies about foreign systems, and once something has been repeated a thousand times it's hard to counter. After all, you can always find someone who has had a problem with any system, and will talk about it – 'Here's someone who didn't get what they needed in X because of government policy' – and say it would be the same in the United States."

"We have no love for our government in the United States," Himmelstein continues wryly, so a tactic is to exploit a fear of the government, and to suggest that the government will control what healthcare you receive. "But in fact, even as things are now, Canadian healthcare has much less interference by outside organizations than the United States. Most Canadians would be shocked and outraged if they experienced as much interference with healthcare as we do. It's 'mother may I' every time I want to order a test. So in effect, I don't even get to elect those who tell me what to do."

Those without health insurance, who are anxiously awaiting a national plan, may well wonder how long would it take to implement, should such a plan be instituted. According to Himmelstein, logistically, the program could be implemented in a mere six months. This is roughly the time it took to implement Medicare nationwide, which was accomplished in the mid-1960s without the aid of computers.

"Of course, there is a lot that needs to be done beyond a national health insurance plan to fix our healthcare system," Himmelstein points out. "This is not a Nirvana that will solve all of our problems."

It would solve the problem of how healthcare is financed, would eliminate vast amounts of waste that exist now, and would, of course, protect those millions who have no insurance and those who are underinsured. How much money would be recaptured by eliminating the private insurance industry? About $350 billion annually, as administrative costs under the current system consume 31% of healthcare dollars spent. But once the main health financing problems are dealt with, a new range of fights would be opened up. "Doctors say we need as many resources as we can to do the best work we can, and government will say we can't afford it." What is the appropriate level of spending on healthcare?

And there is the legitimate concern of all of the people who work in the insurance industry suddenly finding themselves out of work. To help, PNHP recommends $20 billion in funding for transition programs for those in insurance to find other work.

United States National Health Insurance Act HR 676, which was introduced in January 2007 by Representative John Conyers (D-Mich), had as of June 2008, an impressive 90 co-sponsors. The bill would create an American national universal health insurance program that would be publicly financed and privately delivered, and which would use expand on the already existing Medicare program to provide coverage for all Americans. PHNP endorses HR 676.

But does HR 676 have a chance? "In short-term, no but in the long-term, clearly so," Himmelstein says. "It's popular with people, and has the most co-sponsors of any bill in Congress. The healthcare system is crumbling, and not just for the poor, but also for the doctors and other healthcare professionals. There will be another round of discussion over the next few years, and then We know major social change happens suddenly, but unexpectedly."