American College of Physicians Calls for Series of Reforms, Including Single Payer or Public Option

Jan. 22, 2020
ACP also critiques value-based payment’s fragmented approach, saying it layers dozens of reporting programs and reform models, each with its own flawed and misaligned metrics, on top of a fee-for-service foundation

In a series of policy papers published as a supplement in Annals of Internal Medicine, the American College of Physicians (ACP) has called for several reforms to the U.S. healthcare system, including transitioning to a single-payer financing system or a publicly financed coverage option with regulated private insurance.

The ACP’s 141,000 U.S. members are internal medicine specialists. The organization is the second-largest physician group in the country after the American Medical Association, which has opposed broadening public financing of healthcare insurance. The ACP’s set of interlocking policy proposals for what ails the U.S. healthcare system includes a call to action that challenges the country not to settle for the status quo, but to implement systematic reforms.

In a statement explaining the policy proposals,  ACP President Robert M. McLean, M.D., said, “ACP set out to develop this new vision for health care by asking, ‘What would a better healthcare system for all Americans look like?’ We believe that American healthcare costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and underinvests in public health; spends too much on administration at the expense of patient care; and fosters barriers to care for and discrimination against vulnerable individuals.”

The ACP asserts that under a single-payer or public-option model, cost-sharing should be eliminated and payments to physicians and other health professionals, hospitals, and others delivering healthcare services must be sufficient to ensure access and not perpetuate existing inequities including the undervaluation of primary and cognitive care. 

The ACP proposal coincides with the publication of an open letter published in the New York Times and signed by more than 2,000 physicians “prescribing” Medicare for All, an effort organized by advocates separately from the ACP.

 Along with the ACP’s position paper, the Annals of Internal Medicine published an editorial by Drs. Steffie Woolhandler and David Himmelstein, co-founders of Physicians for a National Health Plan, who noted that organized medicine had opposed national health insurance for a century and called the ACP’s new position “a sea change for the medical profession.”

The ACP also calls for ending discrimination and disparities in access and care based on personal characteristics, correcting workforce shortages including the under-supply of primary care physicians, and understanding and ameliorating social determinants of health.

The ACP also has suggestions related to health IT and value-based payment (VBP). Although it supports the goal of payments aligned to promote high-value, patient- and family-centered care, it notes that “VBP as currently implemented has mostly failed to achieve better outcomes at lower cost to patients. This is largely because transformation to VBP has taken a fragmented approach by layering dozens of reporting programs and VBP reform models, each with their own flawed and misaligned metrics, on top of a fee-for-service foundation that often is at odds with goals to reward quality and efficiency.”

The ACP argues that a more fundamental restructuring of payment policies and delivery systems is required to achieve its vision of a healthcare system where payment and delivery systems put the interests of patients first and supports physicians and their care teams to deliver high-value, patient-centered care. “Payment reform must be accompanied by healthcare delivery redesigned around patients' needs and supported by health information technology (IT) systems that enhance the patient–physician relationship, facilitate communication across the care continuum, and support improvements in patient care.”