The paradox is inescapable. The United States pays more for health care by any measure than any other nation in the world, yet the quality of health care in the U.S. has been declining for decades. In a problem unique to the United States compared to other industrialized nations, tens of millions of citizens and residents in the U.S. cannot access health care because they have no health insurance, or it is inadequate, or it is too expensive to use. The difference is that in all those other countries there is a significant public, not-for-profit, health care sector that bypasses the profit morass and delivers cost-effective, high-quality health care.

Legislation which would establish a national health service has been advocated for decades in the U.S., most notably legislation sponsored by former Congressman Ron Dellums, and now by Sen. Barbara Boxer (D-Calif.). Key elements of a national health service include:

• Elimination of profit from all aspects of medical care and public health.

• Payment for all medical care and public health from corporate and truly progressive personal income taxes.

• Delivery of all health care and public health services from publicly owned facilities.

• Delivery of all health care and public health services by salaried public health care providers and workers who earn a living wage, have job security and adequate benefits, and have the right to organize.

• A tiered system of governance relying on local, regional and national elected boards.

• A national system of quality assurance.

Just such a proposal has been studied for California. A few years ago the federal government’s State Planning Grant Program provided California with funding to develop several plans to cover its uninsured populations. California created the Health Care Options Project, which requested proposals that could expand health care coverage.

The state contracted with consultants to evaluate the resulting plans. The California Health Service Plan (CHSP) was one of nine plans evaluated through this process. The California Health Service Plan is really a national health service plan at the state level.

Dr. Ellen Shaffer, the author of the plan, says, “The CHSP calls for public acquisition and ownership of the delivery system [in other words, public ownership of all hospitals and clinics — DL] to provide public authority and accountability for critical reforms. These include increasing and redistributing primary care providers, financing multidisciplinary education for health care workers, and creating group practices in which teams of providers collaborate to achieve improvements in safety and quality. Clinicians would be reimbursed by salary, with both organizational and limited financial incentives permitted for performance.”

The CHSP was extensively evaluated, along with the other eight plans submitted for consideration, by the Lewin Group, a national consulting group not known to have progressive leanings. The Lewin analysis found that the CHSP would be more cost effective than any other plan submitted, and would also provide access to health care for all Californians. Dr. Shaffer summarizes the Lewin Group findings: “The CHSP plan would save $4.6 billion in the first year compared with present total health spending, and $45.3 billion in 2012, after full phase-in of primary care reforms. This estimate also includes the cost to the state of acquiring hospitals and other components of the delivery system.”

“The model also showed that households would save an average of $813 a year from the CHSP, after accounting for effects such as increased taxes, with variations by age and income. All households earning less than $100,000 a year would save money. Households earning $30,000 to $50,000 a year would save $1,615, whereas those with incomes over $150,000 would pay an additional $234 a month, or about 1.8 percent of their income, in return for comprehensive benefits.”

There is only one way to guarantee high quality health care for all the people, and that is to eliminate profit entirely from the delivery of health care and public health services. Any calls for universal health coverage should strongly consider the results of the California study, since it is only with this kind of model that universal health care be achieved.