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HEALTHCARE
COVERAGE

cies with the highest medical expenses lapse, dropping plans offered The ACP champions caring for vulnerable people so that no person is
previously, or confusing members through their telephonic customer left behind. Over the past two years, significant health disparities have
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service and confusing websites. In a similar fashion, the ACA private been evident in our nation. Those with lower incomes were unable to
insurer run plans implement these strategies to remove a de facto “high- stay home, get large government payments, afford childcare and use the
risk pool” of patients with greater severity of illness, pre-existing con- internet to “zoom” to work. They went into their jobs at their own peril
ditions and higher costs for medical care per year. Despite government as cleaners, cooks, grocery workers, firefighters, construction workers,
attempts to thwart the insurers strategies, costs continue to rise as does nurses and aides, doctors, teachers, police and other critical personnel.
administrative overhead charged by insurers. An advantage of “public As a result, deaths in these groups were higher than in protected groups
choice” would be avoidance of confrontation with powerful health plans particularly before vaccines were available and widely distributed.
and their lobbies, and the option to allow individuals to retain their Has the time come for us to switch to a single payer system? Will
current insurance coverage. such a system fix all the problems in our current healthcare dilemma?
How do the options, single payer versus public choice compare? In Clearly these changes will not fix all our problems and will contribute
a single payer system, if all providers, doctors and hospitals were in one to a massive bureaucracy larger than that many of us have seen in the
network, it would end self-selecting out of networks which now results Veteran’s Administration, the Military and in Medicare. Although the
in small networks of willing providers and longer wait times or unavail- ACP recommended these changes two years ago, we are in for a pro-
ability in some areas for poor or high-risk patients. The overhead of longed period of debate and discussion. We present this now for our
each office would be reduced as fewer staff would be needed for col- members to begin to formulate their own best solutions and practices
lections and insurance follow-up. It would not exclude the inevitable to the problems that confront us in delivering the best care to our pa-
“Blue Stockings” trade which is always available to those able and will- tients and all members of our community.
ing to pay for care outside of the system. Public choice would require a
much more robust regulatory arm to assure fair application of Federal References
and State resources and would not assure great cost savings as single 1. San Antonio Express News. Special Feature. A broken system got
payer would. worse: How COVID ravaged San Antonio’s South Side by Laura
According to a Congressional Budget Office report in December of Garcia 4/20/22
2020, single payer would raise worker wages since employers would no 2. Envisioning a better US healthcare system for all: a call to action by
longer provide health coverage. It would eliminate a household’s health the American College of Physicians. Doherty, R, Cooney, TG, Miro,
insurance premiums and most out of pocket expenses thus boosting RD et al. AIM vol 172 no.2 (supplement). 1/21/2020. Pp. s3-s6.
disposable income, reduce administrative waste and free up resources Doi:10.7326/M19-2411
for other sectors of the economy. Workers’ health outcomes and 3. The ACP endorsement of single-payer reform: a sea change for the
longevity would be improved, and single payer would create a long- medical profession. Woolhandler, S and Himmelstein, DU. AIM vol
term care program which would compensate unpaid caregivers and in- 172 no.2 (supplement). 1/21/2020. Pp. s60-62. Doi: 10.7326/M19-
4,5
crease wages among care workers. 3375
Other necessary changes suggested by the ACP would include 4. https://www.cbo.gov/system/files/2019-05/55150-singlepayer.pdf
changing the way doctors are paid. Much of the work of primary care Key Design Components and Considerations for Establishing a Sin-
is therapeutic, preventative and cognitive. Rewards would require re- gle-Payer Health Care System CBO 5/2019
distribution to recognize the cost savings to the system of the work 5. https://www.peoplespolicyproject.org/2020/12/11/cbo-medicare-
done in a primary care medical home. For example, by assuring primary for-all-reduces-health-spending/
prevention measures are recommended and discussed, significant sav- CBO: Medicare for All Reduces Health Spending 12/11/2020 by
ings would accrue from earlier diagnosis, preventive care measures, and Matt Breunig
therapeutic recommendations tailored to the individual and their cur- 6. A comprehensive policy framework to understand and address dis-
rent regimens. parities and discrimination health and health care: a policy paper
The ACP recommends universal coverage to avoid safety-net gaps, from the ACP. Serchen, J, Doherty R, Atiq, O, and Hilden H. AIM
join other economic partners who assume that such care is the respon- vol.174 no.4. 4/2021. Pp. S29-31 doi:10.7326/M20-7219
sibility of industrialized and technologically advanced nations, and
avoid the current cost sharing seen when under- and un-insured patients John J. Seidenfeld, MD is the Chair of the BCMS Publications
enter the health care system often through the emergency room door. Committee and a Fellow of the American College of Physicians.

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