Physicians for a National Health Program (PNHP) emerged thirty-five years ago amid the austerity cuts of the Reagan administration, which threatened to hollow out critical social safety-net programs like Medicaid. Rather than marshaling physician support to defend the limited (albeit lifesaving) poverty program, PNHP opted instead to pour its energies into expanding the possibilities of what health care reform could look like in the United States. From its inception, PNHP has committed itself to securing universal, comprehensive single-payer national health insurance. Under a single-payer system, all residents of the United States would be covered for all medically necessary services paid for by progressive taxation.

Since the turn of the twentieth century, both US political parties have faithfully accommodated private interests in their proposed health policy reforms. When doctors David Himmelstein and Steffie Woolhandler cofounded PNHP in the 1980s, support for single-payer health care was largely restricted to the radical left and a handful of progressive policy analysts. The doctors’ belief in health care as a public good emerged from their left-wing commitments and their personal experiences having witnessed the unnecessary suffering of patients in the current system. Later, as researchers, they published groundbreaking studies exposing private insurers’ administrative bloat, waste of resources, and widespread denial of care, revealing a health system in desperate need of transformation.

Writing in the Annals of Internal Medicine in 1988, Woolhandler and Himmelstein offered an explicitly Marxist understanding of the political economy that drives American medicine, a system of extraction that generates profit at the expense of patient health and physician autonomy. The authors envisioned an alternative health care system in the United States that would meet the needs of people, not corporations. “A reorientation of policy will require an alternative coalition of forces capable of resisting the imperatives of pecuniary interests,” wrote Wooldhandler and Himmelstein. “Physicians together with other health care workers and our patients may provide such a force.”