By Jon Queally, managing editor and staff writer at Common Dreams. Originally published at Common Dreams
The fight for Medicare for All received a two-handed boost from tens of thousands of doctors on Monday when the American College of Physicians—in a move described as a “seachange for the medical professions”—officially endorsed a single-payer system as among only one of two possible ways to improve the nation’s healthcare woes.
Representing 159,000 doctors of internal medicine nationwide, the ACP is the largest medical specialty society and second-largest physician group in the country overall after the American Medical Association (AMA).
The ACP delivered its case in a 43-page position paper—titled “Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care“—published in the Annals of Internal Medicineon Monday. According to the paper:
Although the United States leads the world in health care spending, it fares far worse than its peers on coverage and most dimensions of value. Cost and coverage are intertwined. Many Americans cannot affford health insurance, and even those with insurance face substantial cost-related barriers to care. Employer-sponsored insurance is less prevalent and more expensive than in the past, and in response, deductibles have grown and benefits have been cut. The long-term solvency of U.S. public insurance programs is a perennial concern. The United States spends far more on healthcare administration than peer countries. Administrative barriers divert time from patient care and frustrate patients, clinicians, and policymakers. Major changes are needed to a system that costs too much, leaves too many behind, and delivers too little.
Sen. Bernie Sanders (I-Vt.), a leading candidate for the 2020 Democratic presidential nomination and the author of the The Medical for All Act of 2019 now in the U.S. Senate, welcomed the development.
“I am delighted that the American College of Physicians has come out in support of a Medicare for All, single-payer healthcare system,” Sanders said in a statement emailed to Common Dreams.
“All over this country, a growing number of doctors are sick and tired of the enormous waste and bureaucracy that exists in our cruel and dysfunctional healthcare system,” Sanders added. “They are sick and tired of spending time filling out reams of paperwork and arguing with insurance companies. Medicare for All will give doctors the freedom to focus on making their patients healthy, not making health insurance executives wealthy.”
The ACP’s detailed review of the current for-profit system—even with some of the improvements resulting from the Affordable Care Act (ACA)—found that “too many Americans are uninsured or underinsured” and that current spending is “high and unsustainable”—especially as other developed nations show their ability to achieve better or similar outcomes for less while offering universal, government-guaranteed coverage to all.
While it did not say that Medicare for All was the only way to achieve a more equitable, accessible, and sustainable healthcare system, the ACP laid out four key recommendations for achieving universal coverage in the United States. They are:
1. The American College of Physicians recommends that the United States transition to a system that achieves universal coverage with essential benefits and lower administrative costs.
2. Coverage should not be dependent on a person’s place of residence, employment, health status, or income.
3. Coverage should ensure sufficient access to clinicians, hospitals, and other sources of care.
4. Two options could achieve these objectives: a single-payer financing approach, or a publicly financed coverage option to be offered along with regulated private insurance.
While acknowledging that a transition to Medicare for All could be “highly disruptive” to the healthcare system, the ACP said “single-payer financing approach could achieve [its] 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. 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.”
Medicare for All, the paper continued, could also “achieve other key policy objectives, including portability, lower administrative costs and complexity, lower premiums and cost sharing, lower overall health care system costs, better access to care, and better health outcomes, depending on how it is designed and implemented.”
While the ACP in its backing of a single-payer approach also co-endorsed the more incremental step of creating a federally-administered “public option” as a pathway to universal coverage, Drs. Steffie Woolhandler and David Himmelstein, co-founders of Physician for a National Health Program (PNHP), argue the latter would be an inferior avenue if the aim is to cover everyone while reducing overall costs.
According to an op-ed by Woolhandler and Himmelstein, also published in the Annals alongside the ACP’s new position paper, “Achieving universal coverage would be costlier under the “public choice” model the ACP co-endorses along with single payer.”
Unlike a public-private mix of coverage that the public option would represent, the pair write, a single-payer Medicare for All would allow hospitals and doctors to “save billions on billing-related costs” each year, and those savings could be re-purposed “to expand care” to millions for less cost than the status quo.
In a separate but related move to the ACP’s announcement, more than two thousand physicians on Monday announced an open letter to the American public, prescribing single-payer Medicare for All, in a full-page ad in The New York Times that will run in the print edition on Tuesday, January 21, 2020.
Among the doctors “prescribing” Medicare for All as the only serious solution to the nation’s healthcare crisis, said PNHP—which helped organize the effort—”are towering figures in American medicine” and include Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine; Dr. Bernard Lown, developer of the defibrillator; Dr. Paul Farmer, infectious disease expert and founder of Partners in Health; and Dr. Mary Bassett, former New York City Health Commissioner.
The full text of the open letter follows:
We are doctors from across the spectrum of our profession. We serve patients rich and poor, in hospitals and clinics, private offices and public agencies.
We witness daily the inhumanity and irrationality of the current health care system. America funds health care more generously than any other nation, and our hospitals and medical workforce are second to none. Yet despite an abundance of medical resources, care is too often meager.
For the thirty million who remain uninsured and millions more whose insurance is inadequate to their needs, life-saving treatment is often out of reach, deepening health disparities. Oppressive costs and the fear of financial ruin amplify the suffering of illness. Meanwhile, doctors and nurses struggle to provide good care in a bad system. We waste countless hours complying with arcane billing requirements and, along with our patients, imploring insurers to fulfill their promises of coverage.
It is time to transform the way we pay for care — to embrace improved Medicare for All.
Medicare for All would curb soaring drug prices and dismantle the wasteful bureaucracy of private insurance companies, freeing up hundreds of billions of dollars to expand and improve care — while ensuring free choice of doctor and hospital.
Vested interests who profit from the current broken system raise false alarms of dislocation and disruption to incite fear of change. They are wrong. Improved Medicare for All would bring welcome relief to patients, lower costs for families and communities, and allow doctors and nurses to focus on what matters most: caring for our patients.
“As physicians, we see daily the harm that our fragmented, private-insurance based system does to our patients,” noted Dr. Adam Gaffney, president of PNHP and a pulmonary and critical care physician at Harvard Medical School and the Cambridge Health Alliance. “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.”
As physicians, the signatories of the letter said, the answer is obvious: “we prescribe Medicare for All.”
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By including a “Public Option” in the mix, the organization has sown the seeds of their own downfall. As with the NYT ‘endorsement’ of two candidates for the Democrat Party Presidential ticket, this splitting of focus is a strategic mistake. Make no mistake about this, the opponents of ‘Single Payer’ will jump on this and run it into the ground.
Is this the ‘new normal’ in ostensible progressivism? To shoot oneself in the foot before the race?
“Is this the ‘new normal’ in ostensible progressivism? To shoot oneself in the foot before the race?”
If the “progressives” are Democrats or Republicans, you can count on it.
Good point. I’m being convinced that ‘Progressive’ is mutually exclusive with both ‘Democrat’ and ‘Republican.’ (The truth of Gore Vidal’s remark about America’s single political party is becoming glaringly obvious today.)
Remember what Bubba decided to expend his political capital on, at the beginning
of his first term? It’s by design: they have to be careful not to enact any people-benefitting policy, lest the proles get ‘unjustly’ uppity.
It may not be perfect, but it far better than sitting around keeping their mouths shut. Particularly since their emphasis is on Medicare For All.
It doesn’t matter what their emphasis is, by including a ‘Public Option,’ they have almost guaranteed that the entire exercise will be hijacked by a ‘Divide and Rule’ strategy. Either a plain Public Option or M4A would have been preferable. That would have allowed the focusing of the group’s energies in support of at least some sort of health care improvement. Now, by diffusing the focus, they have almost guaranteed that nothing substantive will be accomplished. Either way, the causes of both a Public Option and M4A will be weakened by them being “shown” to be ineffectual.
Thank you for sticking to your point on this, ambrit. I admire and appreciate persistence. Also, sometimes it even works.
I was nervously hemming and hawing before I went into an important meeting, and the institution’s counsel, not necessarily on my side, gave me a great bit of lawyerly advice: “Don’t negotiate with yourself before you get to the table.”
That is a great anecdote and line, must apply that in future, thanks neighbor!
Thanks. It isn’t easy for Type Null personality types such as myself to do so. As ‘neighbor7’ notes, irresolution has been the undoing of many ‘good intentions’ over the ages.
As one of the good foremen I worked under on jobs once said to a group of us: “Make a decision and stick to it. If you’re shown to be wrong, admit it and change accordingly. Once a job is done, if it is done right, no one is going to hassle you about how it got done. Success covers for lots of mistakes.”
Don’t ask me why, but the following thought rose, unbidden, into my consciousness. “We have to learn who we can trust before actually trusting them.” Zen Transactionalism.
AKA talking a good game.
I dunno Ambrit – The Public Option caused as much panic in the privateers last time (in the workup to Obamacare) as Single Payer because the only way private med insurance can operate is by volume and the option would decimate them. Rapidly rotting corpse. Which they deserve. I’m enjoying this brave step by the ACP – wow. And wondering how Joe and Pete and Amy and Liz are gonna try to talk their way outta this one. Pass the popcorn.
Designer popcorn, coming up!
I dunno though Sto. I thought that the ‘Public Option’ was floated originally as a way to short circuit ‘Single Payer.’ Am I suffering from comprehension fail?
In the interests of transparency, I support total National Health for America. Take a chunk of the DoD budget, say, the money used to run those overseas bases, and use it to “pay” for National Health.
Best question of all time: how’re we gonna pay for what costs far less?
I will never understand why Bernie hasn’t made hay with that.
Is it really just that it’s the right thing to do that keeps us from doing it? I don’t want to think so.
Single payer equals one risk pool.
One risk pool lowers costs by:
– concentrating bargaining power for treatments;
– combining the premiums into one pool that pays for all treatments, avoiding adverse selection costs;
– eliminating staff devoted to figuring out multiple, intentionally complex insurance payment/collection schemes;
– eliminating the cost share of multiple insurance agents.
I’m sure that the commentariat can add or provide clarity to this list, which is intended to be just the insurance part. I left profit in because I’m addressing risk pool structure, not whether or not it should be a utility (although it sure as hell better be non-profit, and in the strictest possible way!). These things are not commonly laid out in plain language, so the above is a start.
There are other benefits outside of these, such as (e.g.) bankruptcy prevention and job freedom on the patient side, and elimination of write-offs and overhead reduction on the medical side.
As a thought exercise, think of how the current US system works and figure that back into the above points to increase the cost.
I am too. Totally for single payer/M4A. – and i’m projecting my own attitude when I say that the public option will be a mercy killing for private insurance in no time flat. But I do agree, why even bother. We all know what we want.
The attraction that might appeal most to a broad swath of the public, including those who already have decent employer insurance, is the portability aspect. You could go to any doctor, hospital, etc. in the country, rather than being limited by state, region or narrow networks.
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Interesting, smells like a ‘bot to me. What say you, commentariat?
Either that or a distributed computation net with a slight case of Deming’s Disease.
If it tells you it works “For the Greater good,” then it’s a rogue gaming platform.
I hear you, HF. ‘Misty’ has a new sibling?
Their membership bears the brunt of the costs of our systems of hospital mismanagement so I guess this shouldn’t be too big of a surprise. They get paid less to do more paperwork and have a more holistic engagement with patient care than most other specialties. Some specialties will fight M4A tooth and nail because it threatens to take yachts off their dock.
https://well.blogs.nytimes.com/2011/09/22/how-one-small-group-sets-doctors-pay/
An acquaintance of mine, daughter of a country doctor here in Ontario, told me her father’s reaction when our OMSIP (now OHIP) universal single-payer health system was being implemented back in the ’60’s. “It means we’ll get *paid*!”
HC reforms do better via incrementalism. ACA was too drastic and complicated IMO. A public option solves many problems, and over time is a path towards more UHC and even single payer.
IMO, as physician of over 40 years, and now a Medicare patient, a better, quicker, easier and far less complicated move would be to simply lower Medicare to age 50-55. That would immediately lower Obamacare private sector premiums as most HC risks are age dependent.
Docs in general not for single payer due to the ever present risks of universally decreasing reimbursements. A public option or a lowering of the Medicare age, make the transition easier.
“Docs in general not for single payer due to the ever present risks of universally decreasing reimbursements.
So Docs look out for numero uno at known expense to their patients. Got it.
More time seeing patients (instead of billing) that can’t afford health care today would increase revenues for doctors with reduced per patient overhead. So your profit margin on the reimbursements can drop significantly and you could still come out ahead.
Lower the age to zero.
>HC reforms do better via incrementalism.
The $64k question: better for whom?
Uncle Joe is perfectly positioned for the “pubic option”. This from his website on health insurance. “Like” as Lambert likes to say, is doing a lot of work here. And of course, pinning the boy down on “the cost of like” will not be easy.
Giving Americans a new choice, a public health insurance option like Medicare. If your insurance company isn’t doing right by you, you should have another, better choice. Whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether, the Biden Plan will give you the choice to purchase a public health insurance option like Medicare.
Choice. There’s that word again.
Backgrounder on “choice,” courtesy of Wendell Potter:
https://www.sltrib.com/opinion/commentary/2020/01/15/wendell-potter-how-i/
Wendell Potter’s real good. Dude misses nothing..
I love the Japanese solution. No private companies allowed to operate in their healthcare, The government provides a % and the individual provides the balance through municipally run insurance plans.
It’s important to note that the American College of Physicians represents Internal Medicine primary care and specialists, who have less of a vested interest in the current system. Procedural specialists like surgeons and radiologists, who are making out like bandits in the existing Fee for Service model, are much more likely to be opposed to Medicare for All, and are more motivated to maintain the status quo.
i’m not concerned about funding, but i still have questions about how we can get more health care out of the personnel and health care infrastructure as it exists today….current wait times are often atrocious, so it doesn’t seem like we have that much more capacity…is anyone addressing that aspect?