ACP’s Split Decision: We’re in Favor of Single Payer. Or Maybe a Public Option.

The public "don't rock the boat" option could lead to universal coverage, says the internists' organization
Peter Wehrwein


The New York Times endorsed Elizabeth Warren and Amy Klobuchar last weekend. Derision ensued.

Did the American College of Physicians do something similar this week when it came out for a single-payer or a public option?

Not quite but the internists' organization does seem to have fallen into the same trap of indecision as the newspaper's editorial board. Seeing both sides is not a formula for taking a bold stance.

In a long policy statement published in is Annals of Internal Medicine, the ACP acknowledged that moving to a single-payer would be disruptive, could lead to price controls, and might “perpetuate flaws in the current Medicare payment system, including the undervaluation of primary care." But it also says that “single-payer financing” could mean portability, lower administrative costs, better access to care, and improved outcomes—“depending on how it is designed and implemented.” So much depends on that depending.

ACP set universal coverage as its ultimate goal, and holds up the public option as another means to that end. It would be less disruptive—and maybe, therefore, more likely to weather political and special interest opposition. The policy statements describes how a public option could patch the ACA's coverage holes by, among other things, extending public player insurance to Americans who live in states that didn’t expand Medicaid. The drawbacks mentioned by the ACP include an even more complex regulatory structure (yikes!); the possibility of low physician payments and therefore low physician participation; and, relative to a single payer, less headway in reducing wasteful spending.

All in all, the arguments that the ACP marshals for a single-payer system are stronger and clearer than those it makes for the public option.

But then there is the reality check on whether single-payer financing would ever happen.