Position statement: Single-payer health care and public health care delivery


This position statement was approved at the June 21, 2014 ISPC membership meeting. 

The Illinois Single-Payer Coalition (ISPC) supports the preservation and expansion of public health care delivery systems at every level of government – city, county, state, and federal. This includes public health and mental health clinics, public hospitals, hospitals and clinics run by state-supported universities, and the VA system.

ISPC will join in grassroots movements to support these public assets as our resources allow. We also urge all activists working on issues involving public health care delivery, including community groups and workers, to join the movement for a single-payer system. Together, we can work to create a more equitable health care system.


Our position in a nutshell:

  • Public health care delivery systems are essential to local access to health care.
  • These systems – many of which are currently being privatized, cut back, or eliminated – are unlikely to survive without a single-payer health care system.
  • In its values and its arguments, the single-payer movement parallels the fight to preserve and extend public health care delivery. Activists in these struggles are natural allies.


A single-payer system supports public health care delivery in three critical ways:

  1. In a single-payer system, access to health care is a right, not a commodity available to those who can pay.
  2. A single-payer system relies on health system planning, not market forces, to locate care where it is needed rather than where it can generate profits.
  3. A single-payer system makes public health systems financially viable by:
    1. Reimbursing them for patient care on the same basis as private providers (no charity care, since everyone is covered)
    2. Controlling total health care costs, in part by eliminating the wasteful, profit-driven insurance industry.     


Public health care delivery improves access to care. 

Existing public health care systems serve populations that are under-served by private systems. The loss of such systems is a step backwards from universal access. Therefore, they must be preserved wherever they exist.

Under the single-payer health care system we fight for, most health care delivery will be private. However, replacing our dysfunctional system with a single-payer system doesn’t itself assure that care is accessible to everyone in the short term.

Both before and after implementation of a single-payer system, expansion of public health care facilities and providers may be the most rapid and efficient way to increase access to comprehensive, integrated care for people who don’t have it.


Supporters of public health care delivery and supporters of single-payer health care face the same opposition.

Attacks on public health care delivery and opposition to single-payer health care are intimately related.

  • Both are based on claims, contradicted by evidence, that market forces can provide for the common good better than the public sector can.
  • Both undermine the role of government in protecting and promoting the health and well-being of the people.
  • Both undermine organized labor.
  • Both undermine social solidarity.
  • Both promote the primacy of corporate profits over the needs of people.
  • Both transfer wealth from the bottom up.

Only by working together can we overcome this powerful and well-financed opposition.


Local activists and public health care workers will be key players in a single-payer system.

Under a single-payer health care system, a public or quasi-public board will be responsible for system planning. This board will be accountable to the public, and will require the active and organized participation of local communities. Existing activists’ groups and organized workers fighting to preserve public health care can contribute essential expertise to such boards.

In summary, the fight for single-payer health care is logically closely related to the fight to preserve and expand public health care delivery. Singe-payer activists, organized clients of public health care delivery systems and their communities, and organized public sector health care workers are natural allies in the struggle for health care justice.






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