ACP Publishes Support of Single-Payer System

The American College of Physicians (ACP) endorsed a single-payer reformed system of United States health care in a broad proposal published in an Annals of Internal Medicine supplement.

This support is significant for a number of reasons, not least of which is its influence on the generic belief that physicians are concerned a single payer system would threaten their livelihood. The concern is decades old.

In an accompanying paper, Steffie Woolhandler, MD, MPH, City University of New York at Hunter College, New York, NY, quoted EW Barootes, President of Saskatchewan’s medical association who led a 3-week doctors’ strike in 1962 against that province’s new single-payer program in Canada, “We were afraid it would destroy the profession…that our integrity would be destroyed…that the government would intrude on the private doctor–patient relationship.”

Since 1960, when health care costs in the United States and Canada were similarly matched, Canada’s single-payer system has proven successful, reducing costs by about 40% overall, with administrative costs accounting for the majority of savings. A recent study shows that substantial savings can be made in just the first year of implementing a single-payer model.

In an effort to determine what is necessary to successfully reform US health care today, and follow Canada’s successful example, the ACP considered four main questions:

• Why do so many Americans lack coverage for the care they need?
• Why is US health care so expensive and therefore unaffordable for many?
• What barriers to health care, in addition to coverage and cost, do patients face?
• How do delivery and physician payment systems affect costs, access, quality, and equity?

“Despite high health expenditure, US spending and prices generally do not correlate with better health outcomes,” Robert Doherty, BA, American College of Physicians, Washington, DC, 

and colleagues wrote in their Annals article. “The United States consistently ranks last or near-last in access, administrative efficiency, equity, and health care outcomes.”

The ACP outlined several recommendations that began with their vision of a “health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford.”

Among their recommendations were parameters regarding social determinants of health, delivery systems that put the patient first while supporting physician care teams, and reallocating administrative spend to fund research, increased coverage, and intervention methods.

“The American College of Physicians envisions a health care system where value-based payment programs incentivize collaboration among clinical care team–based members and use only appropriately attributed, evidence-based, and patient-centered measures,” said the ACP.

Their paper emphasized that a “patients voice is paramount in creating a health care system that better meets their needs” but physicians have an equally significant role to play in offering solutions to amend our health care system.

The ACP ended their Vision for US Health Care supplement by quoting Atul Gawande, MD, MPH, an American surgeon, writer, and public health researcher: “Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.” —Edan Stanley