Buzz
An increasing number of doctors are backing proposals where the government would offer health insurance to cover many or all Americans. The American College of Physicians has just published a position paper endorsing both single-payer and public option policies, explaining why it believes these policies would guarantee "coverage and access to necessary care, at a cost that is sustainable for both individuals and the nation."
Even the American Medical Association, which had long opposed such measures—having campaigned against Medicare back in the 1960s—came close to revising its stance last year. (The AMA now publicly supports the Affordable Care Act and advocates for improvements in coverage.)
Almost everyone agrees that the current health system is failing, with many people unable to access the care they need. The ACP asserts that it “believes universal coverage is essential.” While the AMA doesn't use the term 'universal', it has long supported health insurance coverage for all Americans. The debate now centers around how best to achieve this goal and which system presents the fewest challenges.
Here are several reasons why the American College of Physicians believes a single-payer or public option model is the best solution to address the issues in our health care system:
We need to expand coverage to more individuals
It's evident that our current system, where individuals or their employers are responsible for purchasing insurance, fails to provide universal coverage, let alone affordable access. The ACP cites the World Health Organization, which states:
Due to adverse selection [where sicker individuals are more likely to enroll in insurance] and the exclusion of the impoverished, no country has come close to achieving [universal health care] by relying on voluntary insurance as the primary funding model.
The ACP asserts that we require a system that "delivers universal coverage with essential benefits and reduced administrative costs." Private insurance is clearly unable to meet this need.
Coverage should not be determined by your job or health status
The ACP emphasizes that “Coverage should not depend on a person’s location, employment, health condition, or income.”
At present, many of us lose our insurance when we change jobs. We can purchase insurance on the open market, but the cost is based on income—this helps, but we all know people who are unemployed or self-employed and opt to go without insurance due to the high costs.
The ACP argues that coverage should be extended to all individuals, including undocumented immigrants, because, frankly, it makes sense. (Also because public health affects everyone in society, and denying care to some harms everyone.) In 1982, the Supreme Court ruled that children have the right to an education in public schools regardless of immigration status; the ACP believes a similar rationale should apply here.
Everyone should have the ability to actually access care
Another key point in the ACP's position paper is that “Coverage should ensure adequate access to healthcare professionals, hospitals, and other essential services.” If the care you need is out of network, or you can't afford the copay, or if long wait times or other barriers prevent access, the system is failing. While some countries with universal health care face these challenges, they still often perform better than we do.
Coverage and access are goals to be achieved, not policies in themselves, and there is ample room for constructive debate on how best to reach these objectives. The ACP’s position paper provides an insightful read for those interested in exploring the pros and cons of different healthcare systems; nothing is perfect, and the ACP highlights some of the issues it perceives with single-payer and public option models. Here's why they ultimately decided to support these approaches:
The ACP concludes that, of the available models extensively researched and tested, both single-payer and public option systems offer the best chance of achieving universal coverage at a cost affordable to both patients and the nation, while acknowledging that each has its strengths and weaknesses. The ACP recognizes concerns about too much government control over healthcare but points out that the current system already gives insurers—many of which are for-profit—too much control, while the government already plays a significant role in regulating and financing health care.
