The country’s largest medical specialty society Monday said it’s time for the U.S. to transition to a healthcare system that achieves universal coverage for everyone.
The American College of Physicians (ACP), the second-largest physician group in the U.S. representing 159,000 internal medicine doctors, said the country could achieve universal coverage through two approaches: a single-payer system such as “Medicare for All” or a publicly financed coverage option combined with regulated private insurance.
The ACP made that recommendation as part of a sweeping call for comprehensive reform of the U.S. healthcare system outlined in a series of papers published as a supplement in its journal, the Annals of Internal Medicine.
“ACP set out to develop this new vision for healthcare by asking, ‘What would a better healthcare system for all Americans look like?'” said Robert McLean, M.D., ACP president. “We believe that American healthcare costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and under invests in public health; spending too much on administration at the expense of patient care, and fosters barriers to care for and discrimination against vulnerable individuals.”
2 ways to achieve universal coverage
Perhaps the most controversial recommendation is the endorsement of a new payment system in a policy paper addressing coverage and cost of care. Medicare for All or a public option that would combine the choice of a public program or private insurance both are being hotly debated by Democratic presidential candidates.
“The nation's existing healthcare system is inefficient, unaffordable, unsustainable and inaccessible to many,” wrote the paper’s authors.
ACP asserts that under a single-payer or public option model, cost sharing should be eliminated and payments to physicians and other health professionals, hospitals and others delivering healthcare services must be sufficient to ensure access and not perpetuate existing inequities including the undervaluation of primary and cognitive care.
Growing support from physicians for reform
The suggestion that Medicare for All is one possible fix to the country’s expensive healthcare system was welcomed by Physicians for a National Health Program (PNHP), a physicians' group that supports a single-payer system.
In an accompanying editorial, the group’s co-founders, Steffie Woolhandler, M.D., and David Himmelstein, M.D., called the ACP's new position that includes an endorsement of single-payer reform “a sea change for the medical profession.”
“For a century, most U.S. medical organizations opposed national health insurance,” they wrote, presenting arguments for why a single-payer system is the best option.
In fact, the country’s largest physician group, the American Medical Association (AMA), at its annual meeting last June continued to oppose a single-payer approach to reform and instead said the country should build on the Affordable Care Act to help ensure health insurance for patients. That vote by AMA delegates to defeat a resolution that would have rescinded its long-standing opposition to Medicare for All was a narrow one, PNHP said. However, under pressure from Medicare for All supporters, the AMA dropped out of coalition the Partnership for America’s Health Care Future, which opposes single-payer reform, the group said.
PNHP, a nonprofit with more than 23,000 members, isn’t letting up in its push for a single-payer system. It published an open letter signed by more than 2,000 physicians “prescribing” Medicare for All as an advertisement in The New York Times today.
Among the signers are prominent doctors in American medicine including Marcia Angell, M.D., former editor-in-chief of The New England Journal of Medicine; Bernard Lown, M.D., developer of the defibrillator; Paul Farmer, M.D., infectious disease expert and founder of Partners in Health; and Mary Bassett, M.D., former New York City health commissioner.
The ACP’s call for universal coverage and the letter reflect growing support for single-payer reform among physicians, the group said. In a 2019 poll of healthcare workers, almost half of physicians said they support Medicare for All.
“As physicians, we see daily the harm that our fragmented, private-insurance based system does to our patients,” noted Adam Gaffney, M.D, president of PNHP and a pulmonary and critical care physician at Harvard Medical School and the Cambridge Health Alliance, in a statement. “Patients go without the care they need, and physicians squander time and resources on wasteful billing and clerical tasks. Medicare for All would be a much better way—for patients and doctors both.”
“When we started PNHP, doctors who supported single-payer reform were considered radicals, and reporters likened us to 'furriers for animal rights'. Now we're squarely in the mainstream of the medical profession. More and more doctors have realized—often from talking to our Canadian colleagues—that single payer is the only way to cut insurers’ paperwork and profits that siphon hundreds of billions annually from care in the U.S.,” said Woolhandler, who is a fellow of the ACP but not an official spokesperson for that organization.