ACP recommends implementing a single-payer or public option model to provide essential benefits and reduce administrative costs
Feb. 7, 2020 (ACP) – Amid the national debate about the future of the U.S. health care system, the American College of Physicians is calling for universal health care in a policy paper that outlines more than one way to reach this goal.
“The existing health care system has already largely failed to achieve universal coverage, to provide essential benefits, or to constrain wasteful administrative costs,” said Dr. Thomas G. Cooney, an ACP regent and chair of the Health and Public Policy Committee. “Either a single-payer model or a public option model would achieve the goals of universal coverage with essential benefits and reduced administrative costs.”
In January 2020, ACP released an ambitious new plan for the American health care system in a series of policy papers titled, “Better Is Possible: The American College of Physicians Vision for the U.S. Health Care System.” The papers were published in Annals of Internal Medicine.
Cooney co-wrote one of the policy papers titled, “Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care.” According to Cooney, the papers reflect ACP's 2019 policy that “equitable and universal access to appropriate health care is an ethical obligation of society.”
“Through the publication of this collection of papers,” Cooney said, “ACP is acting on that ethical obligation to our patients and society.”
The recommendations on universal coverage laid out in the report were developed following an intensive review of several health coverage models. The recommendations include:
- The United States should move to a universal coverage system that provides medical care regardless of a person's place of residence, employment, health status or income.
- A government-funded single-payer approach is one feasible strategy to reach universal coverage. This approach could provide a variety of benefits, the policy paper says, although “adopting a single-payer system would be highly disruptive and could lead to price controls that would perpetuate flaws in the current Medicare payment system, including the undervaluation of primary care.”
- A public choice model, also known as a “public option,” is another feasible strategy to attain universal coverage. Under the public choice model everyone would be able to choose between a private insurance plans or a new government-backed public plan, both of which would be required to meet a new set of requirements for coverage. However, ACP acknowledges that “public option proposals also have noteworthy disadvantages,” such as complexities that could require price controls that undervalue primary care.
- Any universal health coverage system must provide essential benefits and emphasize high-value care, preferably based on recommendations from an independent expert panel that includes the public, physicians, economists, health services researchers and others with expertise.
- Cost sharing must not undermine access to evidence-based, high-value and essential care, particularly for low-income patients and patients with certain defined chronic diseases and catastrophic illnesses. In general, cost sharing should be income-adjusted through a subsidy mechanism and subject to annual and lifetime out-of-pocket limits. In a public choice model, premiums should be income-adjusted and capped at a percentage of annual income.
- Medical payments must be sufficient to ensure access to necessary care – including primary care – and expand beyond current Medicare rates, which are insufficient.
- Any universal health coverage system must include an automatic and mandatory enrollment mechanism, and it must provide relief from burdensome administrative requirements.
- Funding for either a single-payer or public option model should come from sources such as government spending, employer contributions, progressive taxes on income, tobacco and alcohol excise taxes, value-based cost sharing, reallocation of savings from reduced spending on administration, and system-wide savings and efficiencies.
- Special health care programs for populations such as veterans and Native Americans should continue.
If these recommendations were put in place, “patients would see dramatic differences,” Cooney said. “First and foremost, all would have access to affordable coverage with a package of essential benefits, without concerns for preexisting conditions or unaffordable out-of-pocket costs. Additionally, they would not face surprise billing or the inability to afford prescription medications, diagnostic tests or medical/surgical procedures. Major illness would no longer produce bankruptcy due to gaps in insurance coverage.”
As for physicians, he said, “in our proposed system, primary care physicians would work in a health care system where primary care is supported with a greater investment of resources and where payment levels between complex cognitive care and procedural care are equitable. They would also see a system where patients and physicians are freed of inefficient administrative and billing tasks, documentation requirements are simplified, and payments and charges are more transparent and predictable.”
Finally, Cooney added, physicians “would provide care in a system where health information technologies enhance the patient-physician relationship, facilitate communication across the care continuum, and support improvements in patient care.”
The ACP policy paper “Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care” is available on the Annals of Internal Medicine website.