21 February 2020

Doctors Endorse Universal Health Care

Welcome back. Along with Democratic presidential candidates and many others, the American College of Physicians (ACP) is calling for a comprehensive reform of U.S. health care. 

American College of Physicians,
founded 8 January 1915.
The ACP is the largest medical specialty group in the U.S. and second-largest physician group after the American Medical Association. Membership includes 159,000 internal medicine physicians, related subspecialists and medical students.

The ACP recommends transitioning to a system that achieves universal coverage through two possible avenues: a single-payer financing system or a publicly financed coverage option with regulated private insurance.

ACP’s Call for Action
The ACP’s recent call for action, Envisioning a Better U.S. Health Care System for All, presents the organization’s vision for a better health care system as well as policy recommendations for how to achieve it. The policy papers, published with the call for action in the ACP’s journal, Annals of Internal Medicine, address barriers, coverage and cost, delivery and payment. These are summarized as follows:

Barriers to care and social determinants of health -- End discrimination and disparities in access and care, correct workforce shortages including primary care physicians, and ameliorate social determinants of health; increase efforts to address public health threats from firearms, environmental hazards, climate change, maternal mortality, and substance use, and health risks associated with nicotine, tobacco and electronic nicotine delivery systems.

Coverage and cost of care -- Cost-sharing should be eliminated and payments be sufficient to ensure access and not perpetuate existing inequities including the undervaluation of primary and cognitive care.

Health care delivery and payment -- Redesign health care delivery and payment to support physician-led, team-based care delivery models, increasing payments for primary and cognitive care services, redefining the role of performance measures to focus on value to patients, eliminating “check-the-box” reporting, aligning payment incentives with better outcomes and lower costs, and redesigning health information technology to better meet the needs of clinicians and patients.

Control costs by lowering excessive prices, increasing adoption of global budgets and all-payer rate setting, prioritizing spending and resources, increasing investment in primary care, reducing administrative costs, promoting high-value care, and incorporating comparative effectiveness and cost into clinical guidelines and coverage decisions.

Opposition to Universal Health Care
Possibly the strongest single voice against the ACP’s recommendations is the Partnership for America’s Health Care Future, an alliance of hospital, health insurance and pharmaceutical lobbyists against legislation that would lead to single-payer health care, expanding Medicare or creating Medicare for All.

But the largest opposing collective voice probably comes from those concerned (or blowing a dog whistle) that universal health care is socialized medicine and socialism isn’t American.

Socialized medicine initially referred to government health care systems that both operate the facilities and employ the staff, as in Finland, Israel, Spain and the U.K. In the U.S., that includes the Veterans Administration and the military medical departments.

Those opposing universal health care have expanded the socialized medicine label to cover any publicly funded system, whether or not it also employs the staff. Canada and most Western European countries finance health care but not the care delivery, and so does U.S. Medicare and Medicaid.

Independent review of universal health care (image by
Tim Liedtke from www.thebalance.com/universal-health-care-4156211).
Wrap Up
Forgive me if I appear to be an advocate for any particular heath care system. I’m really not. I’m just troubled about the millions of people in the U.S. without health insurance and the rising costs that impact everyone. I’m also tired of the nonstop TV commercials for prescription drugs. One would think the billions of dollars pharmaceutical companies spend marketing directly to physicians would suffice.

In an earlier blog post, I wrote: [H]ealth care spending in the U.S. is…much greater than in other high-income countries even though many health outcomes in the U.S. are worse (see Health Care Costs). Put it this way, the U.S. is the only wealthy, industrialized nation that does not provide universal health care.

Thanks for stopping by.

American College of Physicians’ papers in Annals of Internal Medicine journal:
ACP call to action: annals.org/aim/fullarticle/2759528/envisioning-better-u-s-health-care-system-all-call-action
Reducing barriers and addressing social determinants of health: annals.org/aim/fullarticle/2759527/envisioning-better-u-s-health-care-system-all-reducing-barriers
Coverage and cost of care: annals.org/aim/fullarticle/2759529/envisioning-better-u-s-health-care-system-all-coverage-cost
Health care delivery and payment system reforms: annals.org/aim/fullarticle/2759526/envisioning-better-u-s-health-care-system-all-health-care

Press release and example articles on ACP call to action and recommendations:

Article on universal health care with status in selected countries: www.thebalance.com/universal-health-care-4156211
Example articles on single payer health care:
Example articles on socialized medicine:
Partnership for America’s Health Care Future:

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