American College of Physicians Endorses Single-Payer System

The second-largest physician group in the US recently recommended the implementation of a single-payer system or public option to achieve universal coverage.

According to a policy plan released on Monday, the American College of Physicians (ACP) stated that a single-payer system would improve care accessibility and affordability in the US, and the group’s official endorsement of the system marks “a sea change for the medical profession.”

The provider industry has historically opposed the implementation of a single-payer system, including the American Medical Association (AMA). In support of their argument, the stakeholders have cited concerns that the system would reduce reimbursement rates and worsen the doctor-patient relationship.

But the tides may be turning. Once a staunch critic of single-payer systems, the AMA narrowly voted in June 2019 to uphold the association’s official opposition to Medicare-for-all and other single-payer proposals. The association later dropped out of a coalition fighting single-payer proposals.

This would have been “unimaginable” in years past, according to a tweet from Bob Doherty, senior vice president of governmental affairs and public policy at ACP.

ACP has been open to the implementation of a single-payer system or public option in the past. But the physician group's latest policy plan explicitly states its endorsement of such a system.

“We believe that American health care 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,” Robert M. McLean, MD, MACP, president of ACP, said in a statement.

Under a single-payer system, ACP explained that cost-sharing would be eliminated and payments to physicians, hospitals, and other healthcare providers must be sufficient to ensure access to care and not perpetuate existing inequities, such as the undervaluation of primary and cognitive care.

Specifically, for physicians, a single-payer system would also reduce administrative burden, free up time for direct patient care, and decrease uncompensated care costs from a lack of insurance or unpaid cost-sharing, ACP stated.

For patients, a single-payer system would also impact their choice of doctor or hospital. But evidence from other countries with single-payer systems shows that patients are satisfied with their care options and equitable coverage helped to eliminate racial, ethnic, and income-related healthcare disparities, ACP added.

“A single-payer financing approach could achieve ACP's vision of a system where everyone will have coverage for and access to the care they need, at a cost they and the country can afford,” the physician group stated in the policy plan. “It also could achieve our vision of a system where spending will have been redirected from health care administration to funding coverage, research, public health, and interventions to address social determinants of health.”

New research from the University of California also found that a single-payer system would save the US money. The study examined the cost of 22 single-payer plans over the past 30 years. In 86 percent of the analyses, healthcare spending fell in the first year, and all suggested the potential for long-term cost savings.

But this study is not enough to convince some industry stakeholders to get on board with a single-payer system.

“We want to work together to lower costs, protect patient choice, expand access, improve quality and foster innovation. And whether it’s called Medicare for All, Medicare buy-in, or the public option, one-size-fits-all health care will never allow us to achieve those goals,” states Partnership for America’s Health Care Future on its website. The group, which includes industry heavy-hitters like Ascension, Community Health Systems, and the Federation of American Hospitals, opposes single-payer proposals.

Under a single-payer system or public option, patients would lose their ability to choose and control their care, and the system would force individuals off their current plans, Partnership for America’s Health Care Future argues. A single-payer system would also lead to long wait times and worse care, as well as heavier taxes.

The group criticized the research from the University of California, contending that the analysis was biased and flawed. It pointed to other studies, including one from the Congressional Budget Office that found a Medicare-for-all system would reduce access to care and dramatically increase federal spending on healthcare.

Medicare-for-all, public option, and other single-payer system proposals have been hotly debated as the 2020 election draws closer. And with the recent endorsement of a single-payer system by ACP, the line distinguishing who is for and against such reform got a little hazier.