ACP calls for U.S. healthcare reform, endorses single-payer or robust public option

The American College of Physicians (ACP) is calling for a comprehensive reform of the U.S. healthcare system including a universal health insurance coverage plan in a series of policy papers released as a supplement to Annals of Internal Medicine.

The policy papers address coverage and cost of care, healthcare payment and delivery systems, as well as barriers to care and social determinants of health offering specific recommendations to create a better healthcare system, according to a news release.

At the forefront of the recommendations is a call for universal healthcare coverage. ACP calls for either a move to a single payer financing healthcare system or a publicly-financed coverage option with regulated private insurance.

The ACP is the largest medical organization to endorse the idea of single payer. In 2019, the AMA narrowly voted to remain opposed to a single-payer system.

“ACP set out to develop this new vision for health care by asking, ‘What would a better health care system for all Americans look like?’” Robert M. McLean, MD, MACP, president of ACP, says in the news release. “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.”

Some of the specific recommendations made by the organization include:

• Ensuring all residents have coverage for and access to the care they need at a cost both they and the country can afford.

• Addressing all social factors that contribute to poor and inequitable health, barriers to care for the vulnerable and underserved are overcome, and no person is discriminated against.

• Putting patients’ interests first in payment and delivery systems while supporting physicians.

• Redirecting unnecessary administrative spending toward healthcare coverage and research, public health, and social determinants of health interventions.

• Delivering high value, evidence-based care within available resources while getting the public and physicians involved in determining priorities, allocating funding and resources.

• Providing primary care with equitable payment levels between complex cognitive care and procedural care, while ensuring payment systems support what internists bring to patient care.

• Aligning financial incentives to achieve better outcomes while lowering costs and reducing inequities in healthcare.

• Removing inefficient administrative and billing tasks, simplifying documentation requirements, making payments and charges more transparent and predictable, and redesigning delivery systems to make them easier for patients to navigate.

• Ensuring value-based payment programs support clinical care team collaboration and only use evidence-based, patient-centered measures.

• Ensuring health information technologies enhance the patient-physician relationship, facilitate communication, and support improvements to patient care.

The policy paper, "Envisioning a Better Health Care System for All: Coverage and Cost of Care", the ACP calls for the country to achieve universal insurance coverage through a move to a single payer financing healthcare system or a publicly-financed coverage option with regulated private insurance.

In "Envisioning a Better Health Care System for All: Health Care Delivery and Payment System Reforms", ACP recommends redesigning healthcare delivery and payment to better support physician-led, team-based care delivery models, as well as increasing payments for primary and cognitive care services.

The final policy paper, "Envisioning a Better Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health," calls for the end of discrimination and disparities in access and care based on personal characteristics, correcting workforce shortages including the lack of primary care physicians, and understanding and working to improve social determinants of health.

“Through this extensive and forward thinking set of papers and recommendations, ACP hopes to lay the foundation for a better health care system for all,” McLean says in the news release. “As internal medicine physicians, we face challenges every day in working through the current system on behalf of patients. We can and must imagine what a better health care system looks like and be committed to attaining it. ACP, through this vision, is willing to accept that challenge, and calls on others to join us. We believe the status quo is an unsustainable model for our country and most importantly, our patients. All of us deserve better and better is possible.”