ACP’s recommendations to achieve universal coverage have
gotten the most attention, support, and controversy:
“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.
Coverage should not be dependent on
a person's place of residence, employment, health status, or income.
Coverage should ensure sufficient
access to clinicians, hospitals, and other sources of care.
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.”
Much of the news coverage, commentary, and social media
discussion of ACP’s recommendations have focused on ACP’s support for a
single-payer financing approach. This is
not surprising, since ACP is the first major national medical specialty society
to say that a single payer system could achieve the goals of universal coverage
that is not dependent on residence, employment, health status or income. Mentioned
less often is that ACP also said a publicly-financed coverage option to be
offered along with regulated private insurance could achieve the same
objectives. ACP’s paper on coverage and
cost discusses that each approach has significant advantages and disadvantages.
ACP’s support for single payer has often been reported as
being in support for “Medicare for All”—creating a good deal of confusion over
whether ACP is endorsing the idea of enrolling everyone in a plan
modeled on Medicare with better benefits, or a particular bill by that name authored
and championed by Senator Bernie Sanders, a leading candidate for the
Democratic nomination for president.
Let me clear things up.
1. ACP does not use the phrase “Medicare for All”
in its policy paper to describe our recommended approaches to coverage. Yet, we’ve found that reporters often
describe ACP’s support for single payer (as one of the two ways to achieve
universal coverage recommended by us, the other being a public option) as supporting
“Medicare for All” in the stories they file.
2. This is because “Medicare for All” is the
shorthand used by many reporters, headline writers, non-partisan think tanks,
pollsters, researchers, and advocates to describe any plan to (1) enroll
everyone in a publicly-funded and administered plan, modeled on Medicare (with expanded
benefits) and (2) eliminate or greatly limit private insurance. When they use this phrase, they are not
usually referring to Senator Sanders’ bill by this name unless they
specifically say so, but rather, the idea of enrolling everyone in a public
plan modeled on Medicare.
3. ACP has been consistent in saying that we have
not endorsed or recommended any particular bill, whether called Medicare for
All or something else, or any political candidate’s health care plans.
4. ACP has been consistent in stating that ACP
cannot, will not, and does not endorse candidates for federal office, or
attempt to influence its members on who they might choose to vote for. Rather, ACP hopes that its policy
recommendations will help inform the debate over ways to achieve universal
coverage, lower costs, improve payment and delivery, and reduce other barriers
to care—from an evidence-based policy perspective of what’s best for patients, not
from a political orientation or agenda.
5. While ACP does not endorse any specific bill or
plan put forth by a candidate, ACP policy supports the idea of a single
payer plan (whether called Medicare for All or something else), that would 1)
enroll everyone in a publicly-funded and administered plan, potentially modeled
on Medicare but with better benefits and (2) eliminate or largely eliminate
private insurance, if it meets our detailed policy recommendations.
6. ACP policy also supports the idea of public
choice/public option that would (1) give everyone the choice of enrolling in a
publicly-funded and administered plan, which potentially could be modeled on
Medicare but with better benefits, or (2) in a qualified private insurance plan
that has comparable benefits as the public plan, if it meets our detailed policy
recommendations.
7. ACP’s
detailed policy recommendations, among other things, say that under a single
payer or a public choice model, cost-sharing should be eliminated for high
value services and for patients with certain chronic conditions, payments to
physicians must be sufficient to ensure access and not be limited by the
current Medicare rates, and payments should not continue the disparities
between complex cognitive and comprehensive care and procedures that existing
in the current Medicare physician fee schedule.
8. Such
detailed policy recommendations can help inform discussion of how closely a
particular plan or bill meets ACP’s objectives, without leading to ACP
endorsement or opposition to them.
In the current hyper-polarized political environment, it’s
unfortunate that the names that people give to proposals can add to
controversy, if misinterpreted as ACP supporting a particular candidate, plan
or bill rather than offering our own ideas to make health care better.
Yet, in my view what’s most important is to get back to the
substance of what ACP recommends and why.
ACP believes, and the evidence shows, that no matter what one chooses to
call it
Enrolling everyone in a publicly financed
and administered plan
Or, alternatively, giving everyone
the choice of enrolling in publicly-financed and administered plan or in
private insurance with comparable benefits
If designed and implemented as ACP
recommends
Would be a vast improvement over
the status quo.
Because, as ACP wrote in
Envisioning
a Better U.S. Health Care System for All: A Call to Action by the American
College of Physicians, “U.S. health care costs too much; leaves too many behind
without affordable coverage; creates incentives that are misaligned with
patients' interests; undervalues primary care and public health; spends too
much on administration at the expense of patient care; fails to invest and
support public health approaches to reduce preventable injuries, deaths,
diseases, and suffering; and fosters barriers to care for and discrimination against
vulnerable individuals.”
Better
is possible.
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