April 2024 Newsletter

What Is NSP Planning for April? 
Be part of a bold movement to achieve national single payer!

April 2024 Webinar – See Change Below!

Sara Nelson, International President of the Association of Flight Attendants-CWA, AFL-CIO, to speak April 10 at the National Single Payer webinar:
Sara Nelson: Unions, Power to the People, and the Battle for Medicare for All

Join National Single Payer Wednesday, April 10, 2024 at 5 pm PT/8 pm ET as we welcome our guest speaker: Sara Nelson, International President of the Association of Flight Attendants-CWA, AFL-CIO who will present “Unions, Power to the People, and the Battle for Medicare for All.”

Guest speaker: Sara Nelson, called “America’s most powerful flight attendant” by the NYT and tapped as a possible Secretary of Labor by the Biden administration, has served as the International President of the Association of Flights Attendants-CWA, AFL-CIO since 2014, and is currently serving her third four-year term. She first became a union member in 1996 when she was hired as a Flight Attendant at United Airlines and today, represents 50,000 of aviation’s first responders at 19 airlines. 

As a union member for nearly 30 years, Sara Nelson has been a leading voice for worker rights and a strong supporter of health care as a human right and Medicare for All, free from corporate profit. Her articulate expression of all the best that our union movement has to offer has impressed millions. She will speak about what a single payer health care system means for workers and for unions and the role unions must play for us to finally win this battle!


After registering, you will receive a confirmation email containing information about joining the webinar.

If you registered for the “Don’t Bust Up Medicare” webinar and would like to attend Sara Nelson’s webinar instead, there is NO need to reregister!
“Don’t Bust Up Medicare and Hand It To the States” has been rescheduled for Wednesday, May 8, 2024. We will be sending out a new link for that webinar.


On March 13, National Single Payer hosted the webinar “Rural Hospitals Under Fire: How Single Payer and Global Budgets Can Save Them.” More than 150 people attended the webinar and heard how 600 rural hospitals, totaling 30% of all rural hospitals in the U.S., are at risk of shuttering. The crisis preceded the pandemic: fewer rural hospitals shut down during COVID 19 due to special financial assistance all hospitals received during the pandemic. But now that the public health emergency has “ended,” rural hospital closures are on the rise. 

Rural hospitals are in trouble not because rural hospital administrators are inefficient and don’t know how to run a hospital, but because it costs more to deliver health care services in rural communities. It is costlier to provide services to a smaller number of patients relative to the fixed costs of the services. Additionally, poor reimbursementfrom private health insurance plans, low financial reserves, large Medicare and Medicaid populations, poor general health, high rates of uninsured, and high poverty levels all contribute to the precarity of rural hospitals. 

Then there are the private equity takeovers that contribute to rural hospital closures. Maureen Tkacik, who spoke at the March 13 webinar, called the state of rural hospitals evidence of the American health care crime scene. You can read all Maureen’s excellent reporting in the American Prospect here

Closure of rural hospitals has outsized consequences for isolated rural communities: residents who live in communities where their hospital closes need to travel longer distances for emergency or inpatient care, they lose places where they obtain laboratory tests or imaging studies, and often, their only source or primary care. And for the country, the closure of rural hospitals threatens the food supply and energy production, because farms, ranches, mines, drilling sites and energy facilities are located predominantly in rural areas. Who looks after these workers when they get sick?

Five years ago, one such resident of rural Riverton, Wyoming, Corte McGuffey, and several others got together when behemoth private equity firm, Apollo Global Management, took over their rural community hospital and ran it to the ground. The story of building their own community hospital is an inspiring tale of David and Goliath, and shows us what organized, mobilized, and committed residents can accomplish. But is asking residents to build their own health facilities the way to save our nation’s rural hospitals?

According to the Center for Healthcare Quality and Payment Reform (CHQPR), the primary reason rural hospitals are at risk of closing is that private insurance plans (including Medicare Advantage) pay them less than what it costs to deliver services to patients. The biggest shortfalls are not from uninsured or Medicaid patients, but losses on privately insured patients are the biggest cause of their overall deficits. Unfortunately, the CHQPR’s recommendations include a set of convoluted requirements that impose monthly payments plus service-based fees when individual services are delivered on health insurance companies. If this isn’t a recipe for further abandonment of rural communities, we don’t know what is!

Why not use a time-tested, evidence-based solution, like hospital global budgets? Hospital global budgets are used successfully by our own Veterans Health Administration (VHA) and around the world by 16 OECD countries. As we learned from Dr. Jim Kahn in the webinar, hospital global budgets pay the overall operating budget (including salaries and supplies) based on past clinical use and costs. Using a controlled rate, these budgets grow over time to reflect changes in input prices as well as reasonable use. They can also be adjusted within years for unexpected contingencies like disease surges, such as the COVID 19 pandemic. Capital spending is budgeted and decided separately. A study published by Dr. Kahn and others found that single payer with global budgets could reduce 10-year hospital spending by $3.3 trillion while achieving universal coverage and equitable funding of hospital infrastructure. Instituting an integrated health care system like the VHA, away from historically hospital-based, specialty-focused health care to one based in ambulatory care where primary care is at the center of all care, in addition to hospital global budgets, could further result in better outcomes and lower costs.

How could global budgets protect rural hospitals under fire? Dr. Kahn explained that global hospital budgets increase efficiency through the reduction of administrative costs such as billing, the elimination of profits, including marketing, and the exclusion of profit-focused expansion. Health quality increases due to the focus on improving and tracking clinical quality processes and outcomes. A guaranteed budget, with necessary adjustments for unexpected increases or decreases in demand, assures stability. Global budgets guarantee equity regardless of the patient population or location and finally, hospital global budgets would ensure hospitals as a local resource to all communities, rural or not. 

We must fight for a health care system that includes everyone, removes barriers to access for the most vulnerable, and unites us all under the same comprehensive, high-quality, equitable, health care system free from the profiteers. Anyone who tries to limit this bold vision by promoting incremental steps or bemoaning “not in our lifetime” is selling you snake oil.

For a greater discussion of these and other points, watch the March 2024 webinar below.




Maureen Tkacik is a Senior Fellow at the American Economic Liberties Project, investigations editor of The American Prospect, and a journalist who has written extensively on corporate greed. James Kahn is professor in the Philip R. Lee Institute for Health Policy Studies and the Department of Epidemiology and Biostatistics at the University of California San Francisco and Editor of the Health Justice Monitor. Corte McGuffey is a resident of Riverton, WY, and Chair of the Riverton Medical District.

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The Real McCoy in Healthcare podcast

Do you want to get down to the joy of working for national single payer? Join us April 24, 2024 for the NSP Working Group Session.This is where the work of educating, activating, organizing, and mobilizing happens! Click here to join our email list and get announcements about our webinars, newsletters, and working group sessions!


National Single Payer is a national, grassroots organization that organizes locally in the struggle for national single payer health care.

We are united by the common principles that health care is a human right, must be free from corporate profit, and must be achieved through national legislation.

We are a 501(c)(4) under the fiscal sponsorship of Americans for Democratic Action. Your donations keep our work alive!


  1. Health care is a human right, and nothing less than the enactment of a national, not-for-profit, single payer program can make that right a reality in the United States.
  2. Coverage must be inclusive of all needed medical care with everybody in and nobody out and that all people deserve the highest level of quality health care.
  3. The health care crisis calls for urgency in building a broad, powerful, bold, and nonpartisan movement that can make possible the enactment of national single payer legislation.
  4. We maintain hope based on our nation’s history of building dynamic movements to abolish slavery, expand voting rights, establish unions, and take on corporate power.
  5. Neither a state-by-state nor an incrementalist strategy is an effective approach to winning national single payer.
  6. Private equity, venture capital, insurance companies, and all profit-making entities must be banned from health care because profit is the cause of high costs, delays, denial of care, poorer quality of care, and premature death.
  7. Conversion of for-profit hospitals and medical care facilities into non-profit entities is critical to serve the needs of people and communities.
  8. Public funding must be progressive, shifting the burden from workers and those with modest incomes to the wealthy.
  9. Inequities in health care based on race, ethnicity, religion, immigration status, class, gender (including pregnancy & gender identity), sexual preference, detention or incarceration, disability, age, and geographic location must be abolished to assure social justice in health care.
  10. Physicians and all health care practitioners must be able to practice free from corporate control and that patients have the right to choose their physician and other health care providers.
  11. A just transition with jobs, education, and income provided for those workers whose work is eliminated by the establishment of a single payer system is imperative.
  12. And, we welcome the discussion of a national health service and the possibility that such a plan can be placed on the nation’s agenda.