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HEALTHCARE
COVERAGE

Repairing a

Broken System:

A New Vision for American

Health Care from the

American College of Physicians

By John J. Seidenfeld, MD

C OVID-19 infections have been more prevalent and more private health insurance system. Specific issues are excessive payer profit

deadly among people living in the southern parts of the city
margins and executive salaries, high administrative costs in each prac-
of San Antonio, where the population is 81 percent His-
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a malpractice system more concerned with punishing a few offenders
panic, according to Laura Garcia of the San Antonio Express News. The tice devoted to filing claims with over 100 insurers per practitioner and
data indicate more people dying from COVID in the Southside zip than improving the overall quality of care. Fraud, waste and abuse con-
codes when compared to Northside code areas. Flaws in the US Health- tribute to these high costs. Macroeconomic concerns include a period
care system were more obvious because of the pandemic, and showed a of increased inflation and economic instability, reduced competitive-
system that fails marginalized people. These failures result in shorter life ness of American manufacturing products because of additional health-
span, higher infant and maternal death rates, higher rates of chronic ill- care costs for each good produced, a widening gap between the rich
ness such as diabetes and heart disease, and poor or no health coverage and the poor, and the fact that many Americans are either not covered
in vulnerable communities compared to others. with health insurance or under-covered and susceptible to medical
In 2020, the American College of Physicians (ACP), the largest or- bankruptcy.
ganization of American Internal Medicine specialists, with over Canada has found that converting to a single payer system has re-
160,000 members described their new vision for American Healthcare duced administrative costs in health care to from 15-20% down to 2%
and called for systemic reform. Currently they endorse single payer re- of premiums. The estimated savings from this switch would be more
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form. Why would they embark on this path when many U.S. Medical than $200 billion per year in the US. With their current single payer
organizations have opposed this change? system, Canadians consistently outpace us in quality outcomes in end
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Major reasons to familiarize yourself with this discussion include the stage renal disease, type 1 and 2 diabetes, maternal and infant mortality
vulnerable Americans who lack health maintaining nutrition, childcare, and cystic fibrosis to name a few. Though many initially claimed that
education, potable drinking water and health insurance coverage. delays in the system would make it impractical, at this time complaints
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Other problems are expenses of the current system that result in a high about access and quality are no different than those in the US.
rate of personal bankruptcy, and a healthcare system that costs as a per- The ACP also includes “public choice” as an alternative which would
centage of gross domestic product (GDP) more than 1.5 times the cost continue to allow competition among insurers but have significantly
of healthcare systems in other developed countries. There are serious less administrative savings compared to a single payer system. Currently
concerns about access to services, and disparities evident during the in Medicare Advantage and Affordable Care Act (ACA) private insurer
pandemic, and equity among citizens. run plans “cherry pick” or choose those with lowest predicted expenses.
Many of us are troubled by the administrative costs of a multi-payer They also pursue a strategy of “lemon dropping” or letting those poli-

12 SAN ANTONIO MEDICINE • September 2022